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Objective: To examine whether personal psychological resources safeguard hospital nurses against adverse workplace consequences, particularly job burnout and the desire to leave the profession. Background: Nursing research has extensively documented the adverse effects of job burnout and staff turnover. With the current nursing shortage, it is imperative to identify resources and strategies that can mitigate adverse workplace outcomes. However, the role of personal psychological resources, or psychological capital, in aiding nurses to perform effectively in their work environment remains relatively unexplored. Study design and methods: This study adopted a cross-sectional survey design. The survey assessed nurses' experienced burnout (MBI-HSS), psychological capital (PCQ-24), and intentions to leave nursing. Hospital nurses (n= 258) from six states of Australia responded to an online anonymous survey between June and November 2022. Results: Respondents indicated a high degree of experienced burnout: 68.6% experienced high emotional exhaustion, 31.8% had high depersonalisation, and 31.8% had low personal accomplishment. Additionally, 38.8% had high intentions to leave the profession. Emotional exhaustion (p<.001, b=.56) and personal accomplishment (p=.006, b=-.15) were significant predictors of turnover intentions. Higher psychological capital was significantly associated with lower emotional exhaustion (p<.001, b=-.42), lower depersonalisation (p<.001, b=-.29), higher personal accomplishment (p<.001, b=.60), and lower turnover intentions (p<.001, b=.44). Discussion: Much of the nursing burnout and intent to leave literature focuses on negative rather than positive aspects of the work environment. Positive responses to workplace stimuli promote positive attitudes such as empowerment, job satisfaction, and organisational commitment that have a tangible impact on personal and occupational wellbeing. This may explain why nurses with stronger personal psychological resources experienced less burnout and voiced fewer intentions to leave the profession. Conclusion: The health and wellbeing of nurses should be a priority for healthcare organisations; the working conditions nurses face in Australian hospitals cause many to be negatively impacted by work stress. Implications for Research, Policy, and Practice: Nurses would benefit from initiatives to enhance their psychological resources. Targeted interventions to develop psychological capital should be examined in a nursing population. This can change policy, thereby benefitting the healthcare system. What is already known about the topic? • Australia is currently facing a shortage of qualified nurses. • Hospital nurses often experience job burnout and high levels of turnover due to the challenging nature of their work environment. • Personal psychological resources have been linked to positive workplace outcomes, such as job satisfaction and organisational commitment, in various settings. What this paper adds: • It demonstrates that nurses possessing greater personal psychological resources experience lower levels of burnout and are less likely to consider leaving the profession. • The paper suggests that implementing targeted interventions designed to enhance nurses' personal psychological resources could be a viable approach for mitigating burnout and turnover intentions (TI). [ABSTRACT FROM AUTHOR]

Objective: The Samoan community has a disproportionately higher incidence of gestational diabetes mellitus (GDM). We explored consumer and healthcare providers' insight into perceptions of risk, attitudes to lifestyle behaviour change and experiences of GDM among Australian Samoan women in South Western Sydney. Methods: Semi-structured interviews and a focus group with Samoan women recruited through three churches, a diabetes and pregnancy clinic in South Western Sydney and via social media were conducted. Semi-structured interviews with healthcare providers' were also conducted. Main themes were thematically analysed to identify recurring patterns using Quirkos software. Identified themes were framed against the constructs of the Health Belief Model. Results: One focus group (n=4) and 12 one-to-one interviews were conducted among Samoan women. Eighteen semi-structured interviews with healthcare providers' were also conducted. There was a high concordance between Samoan women and healthcare providers' regarding perception of risk and barriers to maintaining a healthy lifestyle. However, Samoan women reported negative interactions with healthcare providers' that hindered their behaviour change, while healthcare providers' reported that normalisation of diabetes, confusion of GDM with type 2 diabetes and spiritual health beliefs were deterrents to behaviour change among Samoan women. Conclusion: Cross-cultural factors can influence the uptake of a healthy lifestyle. Future research should consider use of culturally tailored strategies when developing educational resources targeting Samoan women. Implications for research, policy and practice: The participants' viewpoints expressed in this study suggest a critical need for the development of culturally-tailored health promotion strategies for Samoan women and cultural training for healthcare providers', to improve GDM care and subsequent pregnancy outcomes. What is already known about the topic? * There is limited data and research on GDM particularly among the Australian-Samoan community though the available data highlight the significant morbidity and mortality due to diabetes in this population. * Samoan women are at an increased risk of gestational diabetes mellitus. What this paper adds: * This paper provides knowledge and understanding on ways to prevent and manage GDM by investigating the perception of risk and experiences of GDM among Australian Samoan women and healthcare professionals in Sydney. * It provides current evidence base for policy makers and researchers to develop health promotion strategies and interventions that are relevant to the Samoan and other culturally and linguistically diverse (CALD) communities in Australia. [ABSTRACT FROM AUTHOR]

Objective: This study aims to determine the effect of deep breathing and coughing exercise training before surgery on respiratory functions and exercise tolerance in patients with open-heart surgery in the postoperative period. Background: The decrease in respiratory functions and activity tolerance of patients after open heart surgeries reveals the need to improve this situation with effective interventions. Methods: The quasi-experimental study was conducted with 80 patients undergoing open-heart surgery. Data were collected using the patient information form and the patient follow-up form. The patients were taught deep breathing and coughing exercises before the open-heart surgery and were supported in exercising regularly before and after the surgery. The patients' respiratory functions and exercise tolerance were measured and recorded via the patient follow-up form. Results: It was determined that the respiratory capacity, distance, time, and walking speed of the patients in the experimental group during the postoperative period were significantly higher than the control group. Conclusion: Substantially, deep breathing and coughing exercise training administered before surgery to patients undergoing open heart surgery improved respiratory functions and exercise tolerance in the postoperative period. It is recommended that nurses working in open-heart surgery clinics should plan deep breathing and coughing exercise training in the preoperative period and administer them regularly to the patients. Implications for research, policy, and practice: Patients who will undergo open heart surgery should be trained by nurses in the preoperative period. Nurses should teach these patients deep breathing and coughing exercises. In the postoperative period, it should be checked regularly whether the patients do exercises or not. What is already known about the topic? • It is important to teach and practice breathing exercises in patients who will have open heart surgery. • Respiratory training given by nurses in the preoperative period contributes to the management of the postoperative process. What this paper adds: • This article demonstrates the importance of preoperative education for patients undergoing open heart surgery. • In this study, it is shown that open heart surgery has a negative effect on the respiratory capacity and exercise tolerance of the patients. • In addition, in this study, it is shown that the respiratory capacity and exercise tolerance of the patients who were taught preoperative breathing exercises and who performed the exercises in the postoperative period increased in the postoperative period. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has had widespread impacts on the community and has demanded a rapid response from the aged care sector. System changes for infection control have been required including the use of personal protective equipment, lockdowns, visitor restrictions and changes to activities within aged care facilities. Even prior to COVID-19, the high physical and emotional demands of aged care work were recognised. Objective: This study sought to understand aged care workers' experiences of the COVID-19 pandemic. Methods: Using a pragmatic paradigm qualitative data about work experiences during COVID-19 was collected from people employed in different aged care organisations in a range of aged care roles and settings from multiple Australian states. Data was collected using focus groups and interviews conducted online between August-October 2020. Inductive thematic analysis was used to identify key themes in the data. results: Participants included 15 people working across a range of aged care roles including clinical, care and management staff and across both residential and community settings. Five themes were identified which characterised aged care workers thoughts about their jobs during the pandemic. These included intensified procedures and emotional demands, feeling undervalued and detached from the frontline, exposure of existing system deficiencies, recognising teamwork and increased confidence in technology. conclusion: Reflecting on aged care workers' experiences of COVID-19 highlights the need to better support workers and acknowledge their important role in caring for older Australians. This includes at an organisational level by providing supportive environments and access to online resources as well as at the community and policy level by recognising aged care workers as frontline workers. The COVID-19 pandemic has also highlighted existing systemic issues in the aged care sector that need to be addressed for the provision of quality aged care in Australia during the COVID-19 pandemic and into the future. What is already known about the topic? * While the COVID-19 pandemic is affecting the global community, it is disproportionately impacting the aged care sector with higher rates of severe illness and death and wide-ranging system changes to prevent and control the spread of the virus. * Prior to COVID-19, aged care work was associated with high job demands and lack of access to resources to support aged care workers in their role. * Survey data on the Australian RACF workforce found workers felt prepared for the pandemic with a wide range of measures to control the spread of COVID-19 but they faced several challenges associated with their additional roles and restrictions. What this paper adds * This paper provides qualitative and descriptive insights into the challenges experienced by the Australian aged care workforce during COVID-19 including increased workloads and intensified emotional demands of their roles while at the same time feeling undervalued by the wider community. * This study has highlighted the need to better support and acknowledge aged care workers in the community through their portrayal in the media and within their organisations by facilitating supportive team environments and providing access to online resources and training. * This paper discusses existing systemic issues that have been highlighted by COVID-19 and the Royal Commission into Aged Care Quality and Safety and need to be addressed for the wellbeing of workers and the provision of quality aged care. [ABSTRACT FROM AUTHOR]

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]

Objective: To evaluate nurses' satisfaction and experiences of redeployment during COVID-19. Background: Redeployment to an unfamiliar environment can be challenging; however, it can also present an opportunity for staff to learn new skills. During the COVID-19 pandemic, the need to redeploy health professionals, particularly nurses, increased dramatically. Evaluating nurses' satisfaction and experiences related to redeployment during the pandemic is essential for future surge planning. Methods: A cross-sectional online survey consisting of single-choice and open-ended questions was conducted on a purposive sample of nurses (n=106) working in an acute hospital in New South Wales, Australia, from July to August 2020. Nurses who were redeployed to wards different from their regular workplaces were invited to participate in the survey. Areas of redeployment include various medical and surgical wards, intensive care units and the emergency department. Nurses' satisfaction was obtained through the survey question structured as a Likert scale ranging from very satisfied to very dissatisfied. Nurse experiences were captured through a single-choice question (positive or negative experience) and open-ended questions. The single- choice questions were analysed by summarising participant responses, and open-ended questions were analysed using an iterative thematic analysis approach. Results: A high proportion of nurses were either neutral (48.4%, n=45) or dissatisfied (44.1%, n=41) with redeployment, with only 7.5% (n=7) of nurses being satisfied. There was a mix of positive (43%, n=40) and negative (57%, n=53) redeployment experiences. Three main themes influence nurses' redeployment experience: "staff friendly and welcoming", "patient allocation", and "support". Conclusion: Redeployment of healthcare workers during a pandemic is inevitable. This study highlighted that despite close to half of the redeployed nurses reporting a positive redeployment experience, only a few were satisfied with redeployment. This indicated that more work is required to support nurses during redeployment to increase satisfaction. Future workforce redeployment needs to consider healthcare workers' needs and must strive to improve satisfaction to build a sustainable and resilient health system. Implications for research, policy, and practice: This study highlighted that although redeployment is challenging, staff can have a positive redeployment experience when supported. Elements that are associated with positive redeployment experience were explored in this study, which can inform policy and prepare nurses for future surge demand. What is already known about the topic? • Redeployment of nurses in the acute care sector during the COVID-19 pandemic is common. • Both the COVID-19 pandemic and redeployment can be challenging and stressful experiences for nurses. • There is a paucity of research examining the satisfaction and experiences of nurses working in the acute care sector during COVID-19 in Australia. What this paper adds: • This study provides evidence that many nurses working in the acute sector during COVID-19 in Australia had positive redeployment experiences. Despite this, very few were satisfied with redeployment. • This study has identified essential factors to a positive redeployment experience. • This study also highlighted the need to improve nurses' satisfaction with redeployment. [ABSTRACT FROM AUTHOR]

Objective: We conducted a survey to understand the challenges faced by the staff of residential aged care facilities (RACF), during the COVID-19 pandemic. Background: In the current pandemic, the RACF workforce has been required to work under stressful conditions, with immense mental and physical pressures, resulting in anxiety and stress felt towards their jobs. Study design and methods: We electronically surveyed both clinical and non-clinical staff at public and private RACFs in Australia in June and August 2020. The survey asked a mix of openended and closed questions about preparedness for the pandemic, information flow, experience with personal protective equipment (PPE), management of suspected COVID cases, restrictions on visitors, and impact on RACF staff personal and home life. Quantitative data were analysed in SPSS; qualitative data using content analysis. Results: We received 371 responses: 198 from clinical staff and 168 from non-clinical staff. Respondents were between 20--71 years old, and 87% were female most commonly from Victoria (28%) or New South Wales (28%). The majority (80%) felt that Australian RACFs were well-prepared for the pandemic and 87% agreed that relevant healthcare authorities were contactable for information needed. A total of 37% reported challenges in estimating and ordering appropriate quantities of protective equipment. Ninety percent of facilities reported screening residents for possible symptoms and 77% introduced precautions or quarantine measures to protect residents. Most participants (98%) reported their RACF implemented restrictions on visitor access and 43% reported unfair or abusive treatment by family or friends of the residents. Commonly reported personal impacts included: workload increase, stress, emotional toll, family issues and fatigue. Support from colleagues as well as training, de-brief sessions and frequent meetings were identified as helpful facilitators during this time. Conclusion: We identified a wide range of practices and coping strategies among Australian RACFs. Whilst a majority of respondents reported coping well, a large proportion reported struggling both mentally and physically. Factors reported as helpful by the respondents may assist RACFs in planning for future pandemics. Implications for research, policy and practice: Understanding the challenges faced by all levels of staff within RACFs may aid decision-makers on a range of different levels -- researchers, aged care providers, local/regional/state health departments and national leaders within government to help inform the development of interventions that may help the sector to recover, as well as prepare for potential future outbreaks. Of particular importance, are interventions or initiatives that focus on supporting the physical and mental health of staff i.e. those that prevent or minimise worker fatigue, emotional burnout and stress. What is already known about the topic? • Nursing staff in Australian RACFs did not feel prepared for the COVID outbreak in their workplace. • Early in 2020, RACF nurses experienced a greater overall workload and some had their staff hours reduced by their employers due to financial constraints caused by the outbreak. What this paper adds • This paper offers a comprehensive insight into how RACF staff coped both individually and as part of the facility overall during the COVID crisis. • It identified that a commonly reported source of stress was first-hand verbal abuse from family or friends of residents in response to visitor and lockdown restrictions implemented by the authorities. • The paper highlighted that whilst the majority of respondents felt that RACFs were well prepared for managing residents during the pandemic, some facilities experienced significant problems with workloads, PPE and human resourcing. • Furthermore, the survey showed that on an individual level, some staff experienced significant mental and physical stress during the outbreak. [ABSTRACT FROM AUTHOR]

Objective: To investigate third-year undergraduate nursing students' perceptions and views on being prepared for using patient electronic medical records (EMR) in clinical placement after using only paper-based documentation during their education program; and their opinion on the introduction of EMR in the university simulated learning environments to be work ready. Background: Contemporaneous clinical practice in many countries now requires nurses to competently use patient EMR including electronic observation and medication charts. However, Australia has been slow in introducing this learning into undergraduate nursing programs. For this reason, there is a knowledge gap examining nursing students' viewpoints on learning EMR in their undergraduate program in preparation for the clinical environment and future registered nurses in Australia. Methods: All third-year students enrolled in the undergraduate nursing program at one regional metropolitan university in New South Wales (including three campuses) were invited to complete an electronic questionnaire. This survey included questions on the students' perceptions on their confidence and preparedness using EMR in clinical practice based on their current paper-based learning in the university simulation laboratories; and their opinions on the benefits of integrating EMR learning into the undergraduate nursing curriculum. Results: Seventy third-year nursing students completed the questionnaire, a response rate of 13.2%. Most respondents (71.1%) did not feel prepared to use EMR in the clinical setting after only learning paper-based documentation and 81.7% did not feel confident accessing patients EMR the first time. Nearly all students (98.5%) believed they would be more confident using EMR initially in their clinical placements if there had been opportunity to practice using EMR in the university simulation laboratories. There was a significant difference with female participants perceived improved confidence accessing patients EMR, if EMR was integrated into the university simulated laboratories compared to the male participants (p=0.007). Conclusion: In this study, third year nursing students believed that learning to use an EMR program in the university simulated environment will increase their confidence and preparedness when on clinical placement and be work ready as registered nurses. Implications for research, policy and practice: This study showcases the importance of preparing nursing students for entering the workforce as confident and competent new graduate registered nurses and integrating health informatics and digital health technologies universities in undergraduate nursing programs in Australia. Future studies on Australian student's experience with the introduction of an academic EMR program is recommended. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to report on the experience of racial discrimination by black sub-Saharan overseas qualified nurses working in rural Australia. Background: The arrival of black African people as skilled professional migrants is relatively new in rural Australia. The presence of black sub-Saharan African nurses in Australian healthcare facilities is changing the face of the Australian nurse. Australia, like other developed countries, has been receiving migrant nurses from the African continent in a bid to reverse its critical nurse shortage. Literature has shown that globally, overseas qualified nurses of colour have encountered work challenges that have included racial discrimination. Study design and methods: A qualitative hermeneutical phenomenological approach was used. Eighteen nurses were purposively selected using personal invite and a snowballing technique. Data collection involved individual face to face interviews and a focus group discussion. Results: The exploration of experiences revealed issues of race and colour among colleagues and between patients and overseas qualified nurses. Overseas qualified nurses experienced incidents of Objective: The aim of this paper is to report on the experience of racial discrimination by black sub-Saharan overseas qualified nurses working in rural Australia. Background: The arrival of black African people as skilled professional migrants is relatively new in rural Australia. The presence of black sub-Saharan African nurses in Australian healthcare facilities is changing the face of the Australian nurse. Australia, like other developed countries, has been receiving migrant nurses from the African continent in a bid to reverse its critical nurse shortage. Literature has shown that globally, overseas qualified nurses of colour have encountered work challenges that have included racial discrimination. Study design and methods: A qualitative hermeneutical phenomenological approach was used. Eighteen nurses were purposively selected using personal invite and a snowballing technique. Data collection involved individual face to face interviews and a focus group discussion. Results: The exploration of experiences revealed issues of race and colour among colleagues and between patients and overseas qualified nurses. Overseas qualified nurses experienced incidents of Nurse managers need to be more vigilant in monitoring staff interactions in their Units. Understanding and support for diversity at the workplace by all nurses will improve patient and staff safety. [ABSTRACT FROM AUTHOR]

Objective: To find out if non-invasive ventilation (NIV) as a ventilation modality increases the burden on nursing personnel and give suggestions how the presence of non-medical caregivers in an ICU with an extreme staff shortage can reduce nursing workload during mechanical ventilation. Background: Although the European Union offers good quality healthcare, there are middle-income countries in the alliance that suffer from nursing staff shortage. For example, Bulgaria needs two times more nurses than it has now to meet the needs of its healthcare system. This calls for strategies that reduce nursing workload as much as possible. There is a common perception that NIV is more time-consuming for nurses compared to invasive mechanical ventilation (IMV) but only a few studies discuss the matter and none of them are settled in the unique environment where medical and non-medical caregivers provide direct patient care as a team. Study design and methods: This is an observational study conducted in a specialised respiratory ICU with trained nurses, physiotherapists, and non-medical caregivers in a university hospital in Bulgaria. Ninety adult patients (43 on NIV and 47 on IMV) with acute respiratory failure that were on mechanical ventilation for at least five days were included. Nursing workload was measured via the Nursing Activities Score (NAS). Average and daily NAS were compared between groups. Then individual components of the score were analysed to determine which activities have the greatest impact on nursing workload. Results: Average (39.72 ± 6.35 vs 46.08 ± 5,66, p< 0.001) and daily NAS for the first five days of mechanical ventilation and was significantly higher in the IMV group. There was a substantial drop of nurse workload with time in both groups, more significant for the patients who ventilated invasively. It occurred on the second day in both groups (NIV: p=0.005, 95%CI: 0.88-4.52; IMV: (p<0,001, 95%CI: 2.72-7.03). NIV patients required more time for monitoring but less for hygiene, fluid administration and nutrition. IMV patients also required specific care for their artificial airway and took more time for lung function improvement procedures. Conclusion: In a setting where direct patient care is provided by both formally trained nurses and nonmedical caregivers IMV was associated with a higher nursing workload than NIV. Implications for research, policy, and practice: In a situation with an extreme staff shortage some of the non-medical nursing activities involving patients on NIV can be potentially transferred to trained nonmedical caregivers. What is already known about the topic? * According to the World Health Organization in 2018 there was a nurse shortage of around six million and by 2030 it will increase to 36 million. This negative trend is most prominent in low- and middle-income countries. * There is a common perception that NIV is more time-consuming for nurses compared to IMV but only a few research groups address this matter. * NIV may require additional time from nursing personnel mainly because of problems with mask fit, skin breakdown and maintenance of an optimal position in bed. NIV is more time-consuming in the first 48 h but then becomes much less demanding. What this paper adds * This is the first study where the ICU nursing workload during NIV and IMV is compared in a setting where non-medical caregivers have a substantial role in direct patient care. * In a setting where direct patient care is provided by both formally trained nurses and non-medical caregivers IMV was associated with a higher nursing workload than NIV. * In a situation with an extreme staff shortage some of the non-medical nursing activities involving patients on NIV (like help with self-hygiene, food, and water intake) can be potentially transferred to trained non-medical caregivers under supervision. [ABSTRACT FROM AUTHOR]

Objective: The aim was to explore and compare documentation of the nursing process for patient safety in two nursing documentation systems: paper and digital records. Background: The 'nursing process' (assessment, planning, intervention, and evaluation) is recommended by professional nursing registration and health service accreditation bodies as a key component of understanding nurses' clinical reasoning. Nurses' responsibility for patient safety must be supported by comprehensive documentation practices. Study design and methods: A retrospective audit of twenty clinical care records (N = 20) randomly selected from a single acute medical ward at a tertiary hospital in Australia; ten from a digital trial that replicated selected paper forms and ten paper records as controls. The audit was conducted by two nurse researchers using a purpose built data extraction tool. Results: Patient age, gender and primary diagnoses were similar for the digital and paper care records. Documentation of the full nursing process was low in both record types, and comprehensiveness of nursing documentation was similar across the paper and digital records. Compared to the paper documents, the digital documents were more often rated as 'complete' (p<0.05). Documentation of risk to skin integrity (p<0.05) and evidence of completed nursing interventions to address risks were more frequent (p<0.05) in digital records. Discussion: The findings of this study highlight an important gap in comprehensive documentation of the nursing process that supports and informs the clinical reasoning of nurses for patient safety. Improvements in digital documents reflect future opportunity to enhance the quality of nurse documentation using technology specific strategies such as prompts, visualisation and nudge. Conclusion: This research identifies that both paper and digital systems of hospital documentation may fail to capture and communicate the clinical reasoning of nurses. Digital systems have the potential to improve capture of the clinical reasoning and nursing process. What is already known about the topic? * Professional registration and healthcare accreditation bodies recommend nurses' clinical decision making is underpinned by processes of assessment, planning, intervention and evaluation. * Poor capture of nurses' clinical decision making in their documentation has negative consequences for the continuity, quality and safety of care; including inadequate detection of deterioration and escalation of care. * Electronic systems are expected to enhance capture of nurse decision making in documentation. What this paper adds: * Nurses' clinical reasoning was poorly captured in both paper and digital documentation systems. * Nurses documented their intervention responses to identified patient risks more often in the digital system compared to paper records. * Digital systems offer an opportunity to proactively nudge nurses towards improved documentation of nursing processes. [ABSTRACT FROM AUTHOR]

Objective: To explore factors that can influence implementation of a nurse-led model of care for early medication abortion provision in the primary healthcare setting of regional and rural Victoria, Australia. Background: Global research indicates that an increased involvement of primary healthcare nurses in the delivery of early medication abortion provision has the potential to improve abortion access. In Victoria, access in regional and rural areas is restricted despite abortion being legal. A nurse-led early medication abortion provision model is feasible and can potentially improve the current situation. Study design and methods: An online three-round classic Delphi method was used. This paper reports the qualitative findings. Non-probability sampling techniques were used to recruit a panel of professional experts. Data from the three questionnaires were collected and analysed using thematic analysis. Factors influencing model implementation were categorised into the Capability, Opportunity, Motivation-Behaviour framework. Results: A total of 24 medical and other health professionals participated. They identified a range of factors that can hinder model implementation, including a lack of affordable medication abortion education, no remuneration for nurse-led early medication abortion provision, and concerns related to stigma and support. Discussion and conclusion: Understanding and addressing barriers to model implementation may enable the development of primary healthcare nurses' role in the delivery of early medication abortion provision to improve abortion access. Impact: To improve abortion access in Victoria's under-served regions, the potential of nurse-led early medication abortion provision was explored. Barriers to model implementation relate to a lack of medication abortion education and funding, professional support and stigma concerns. The study identified a range of support elements that would enable primary healthcare nurses to develop new roles and responsibilities in the delivery of medication abortion services. What is already known about the topic? * Evidence indicates that appropriately trained primary healthcare nurses can provide early medication abortion and associated tasks as effectively, safely and satisfactorily as physicians. * Nurse-led early medication abortion provision is a worldwide recognised strategy to overcome the shortage of early medication abortion providers and to improve equity in access to abortion services. * The legal climate of Victoria allows qualified registered nurses to independently administer physician-prescribed early medication abortion drugs to women. What this paper adds: * The Delphi panellists of this study all endorsed nurse-led early medication abortion provision in regional and rural Victoria and beyond. * The study provides a range of model implementation barriers, which are categorised into the components of the Capability, Opportunity, and Motivation Model of Behaviour. Those barriers need to be challenged and addressed to improve abortion access in underserved regions. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the training and implementation of the gravimetric method for estimating postpartum blood loss in clinical practice in Indonesian midwife-led birth centres. Background: Postpartum haemorrhage remains a leading cause of maternal death, particularly in low-resource settings. There is no gold standard for assessing blood loss volume during labour and childbirth. Studies recommended using a gravimetric method to measure blood loss in low-resource settings due to its relative accuracy and simplicity. Study design and methods: An online training module for the use of the gravimetric method was developed. All participants undertook the training and were asked to implement the method in clinical practice. A pre/post-test study design was used to examine midwives' understanding of the gravimetric method; their implementation experience was explored using a structured questionnaire. Knowledge was assessed pre-training. The training consisted of both theoretical and practical elements and the opportunity for participants to ask questions. Post-training tests were administered, followed by a one-month period of implementation and an evaluation of their experience of using the method in practice. Results: Two hundred and eighty-five midwives from 17 health facilities were recruited to the study, and a total of 101 midwives from 12 health facilities completed all elements. The participants' understanding of the gravimetric method improved significantly following the training. Although a number of challenges were identified regarding the implementation of the gravimetric method in practice, the participants were generally positive about its use, and 89% said that they would recommend this method to colleagues. Conclusion: A three-hour online training effectively improved participants' understanding of the gravimetric method for assessing blood loss volume. This study identified midwives' positive experiences with the gravimetric method and identified areas to improve practitioner experience of implementation in practice. Implications for research, policy, and practice: A three-hour online training followed by a onemonth implementation period could be an effective and efficient approach to developing midwives' understanding and use of the gravimetric method of blood loss estimation postpartum. What is already known about the topic? * The gravimetric method estimates the blood loss volume by weighing sanitary materials used during the labour process (i.e., gauze, sheets, swabs, pads, etc.) before and after being contaminated by the blood. * In clinical practice, the weight difference (in grams) is considered as 'blood loss volume' for ease of measurement and reported in millilitres without any formal conversion of units of weight to volume. * The benefits of the gravimetric method have been reported previously. However, there is limited evidence on the evaluation of this method to train midwives regarding implementation of the gravimetric method in clinical practice. What this paper adds * An online training programme is effective in increasing midwives' knowledge and awareness of the gravimetric method for postpartum blood loss assessment. * The midwives found the gravimetric method simple to adopt in clinical practice, which increased their confidence in detecting postpartum haemorrhage. * The midwives encountered some barriers while implementing the gravimetric method and provided strategies to mitigate the issues raised. [ABSTRACT FROM AUTHOR]

Objective: To trial the Supportive and Palliative Care Indicators Tool (SPICT) as a nurse-led initiative to describe the supportive and palliative care needs of patients in the acute general medical ward. Patient deaths within the subsequent 12 months were identified. Background: National standards specify recognition of patients at risk of deterioration and dying as essential to ensure high quality and safe end-of-life care. However, the timely recognition of these patients in acute medical wards is often complex and inherently uncertain. Method: A point prevalence study assessed the supportive and palliative care needs of patients admitted to the general medical wards of a major public tertiary hospital in a single day. A nurse-led team used the SPICT and the Surprise Question to assess patients. Patient deaths were identified one year following assessment. Results: Most admitted patients (n = 40, 93%) exhibited at least one advanced disease and two indicators of general deterioration on assessment. Of these patients, 40% died within one year. Only one patient was referred to the hospital-based palliative care service at the time of assessment. Conclusion: The SPICT identified a high prevalence of supportive and palliative care needs among general medicine inpatients. The use of the SPICT as a nurse-led initiative provides an opportunity to identify patients at risk of deteriorating and dying while also recognising areas of unmet need. Implications for research, policy, and practice: The SPICT can be effectively administered by nursing teams to assist with the identification of patients who may be at risk of deteriorating and dying so that appropriate end-of-life care decisions can be considered. Further work is needed to develop supportive measures to assist home teams in the identification and response to patients at risk of deterioration and dying in acute hospitals. What is already known about the topic? * Accreditation standards specify that hospitals are required to promptly recognise patients at high risk of deteriorating or dying within 12 months. * The timely recognition of these patients is often complex and inherently uncertain in the acute medical setting. * The Supportive and Palliative Care Indicators Tool (SPICT) can help multidisciplinary teams identify patients who may be at risk of deteriorating and dying in all care settings. What this paper adds * This snapshot study revealed >90% of patients admitted to our general medical wards presented with advanced disease and indicators of deterioration. Forty percent of these patients died within 12 months following their admission. * The SPICT can be effectively administered by nursing teams to assist in the recognition of these vulnerable patients so that appropriate end-of-life care decisions can be considered. [ABSTRACT FROM AUTHOR]

Objective: To investigate the psychosocial effects of the COVID-19 pandemic on nurses and midwives working in acute care settings, specifically psychological distress, self-reported concerns, and perceived impact on their work and personal lives. Background: Little is known about the psychosocial impact of the pandemic on nurses and midwives in Australia, a country with a substantially lower number of COVID-19 cases and deaths than many others. Few studies investigating the prevalence of psychological distress among nurses during the pandemic have been conducted in more than one setting, especially in the Australian context. Study design and methods: Cross-sectional survey design (STROBE checklist). Nurses and midwives (n=1,611) at four metropolitan tertiary health services in Melbourne, Australia completed an anonymous online survey between 15 May and 31 August 2020, which assessed symptoms of depression, anxiety and stress (DASS-21); concerns related to COVID-19; and other effects of COVID-19. Space was provided for free-text comments. Results: Approximately one fifth of respondents reported moderate to extremely severe symptoms of depression, anxiety and stress. Fewer years of clinical experience were significantly associated with higher levels of psychological distress. More than half of the respondents were extremely/very concerned about passing COVID-19 on to family members and about their family's health, and almost half were concerned about caring for a patient who had confirmed or suspected COVID-19. Respondents reported that certain precautionary measures such as personal protective equipment (PPE) interfered with their ability to provide optimal patient care. Positive aspects of the pandemic were also reported including a sense of togetherness and cooperation among staff. Conclusion: The COVID-19 pandemic has had a considerable impact on the psychological wellbeing and work and personal lives of nurses and midwives working in acute care settings in Melbourne, Australia, particularly those with less clinical experience. Implications for nursing and health services research, policy and practice: Nurses and midwives, particularly those with less clinical experience, would benefit from additional, targeted wellbeing and support initiatives. For those with less experience, initiatives could include being partnered with more experienced colleagues and educators who can provide practical and emotional support and monitor their stress levels. What is already known about the topic? * Nurses and midwives have experienced more psychological distress than other healthcare workers during the COVID-19 pandemic. * Most studies about the psychosocial impact of the COVID-19 pandemic on nurses and midwives have been conducted in a single health service. * Few studies have concurrently investigated the experiences of nurses and midwives from different health services during the COVID-19 pandemic especially in the Australian context. What this paper adds * Despite the relatively low number of COVID-19 cases and deaths in Australia, the COVID-19 pandemic has had a considerable impact on the psychological wellbeing and work and personal lives of Australian nurses and midwives. * About one in five of the nurses and midwives surveyed reported moderate to extremely severe symptoms of depression, anxiety and stress during the first wave of the pandemic. * Nurses and midwives with fewer years of clinical experience experienced higher levels of psychological distress than those with more experience. [ABSTRACT FROM AUTHOR]

Objective: To describe the roles that Australian nurses play, the breadth of skills that they deploy, and the range of contexts in which they practice. Study design and methods: This cross-sectional study used a descriptive survey where data were collected online using Qualtrics©. Survey respondents were nurses whose primary role was caring for people with intellectual and developmental disability. In addition to demographic data, the main outcome measures were: nursing roles, practice and context. Results: Complete responses were collected from 101 nurses; 78 females and 22 males completed the survey, the majority of whom (n=70) were from New South Wales. The major focus of care was direct assessment and care, followed by supervision of support workers, education, and advocacy for people with intellectual and developmental disability. Physical healthcare was consistent across body systems, as it was for all adaptive behaviour domains. Support for mental illness was more likely to be for depression and anxiety. Nurses liaise with a multitude of health and social agencies as part of their nursing practice. Discussion: This is the first study to capture the roles, practice and contexts of these Australian nurses. Nurses caring for people with IDD play a variety of roles and engage in a vast array of practice related to the physical and social needs of people with intellectual and developmental disability across the whole of the lifespan and in multiple, disparate contexts. Conclusion: It is important for the ongoing care of people with intellectual and developmental disability that the value added by this nursing workforce not be overlooked as disability and health policies evolve. Implications for research, policy and practice: This cross sectional study lays the groundwork for further research about these Australian nurses, in particular more focussed research about the economic benefits of disability services employing nurses, description and effect of nursing interventions specific to people with intellectual and developmental disability, as well as theoretical work to conceptualise new, National Disability Insurance Scheme-ready, models of nursing care for people with intellectual and developmental disability. What is already known about the topic? * In the Australian context, little is known about the contemporary roles and practice of nurses who care for people with intellectual and developmental disability. What this paper adds: * This paper offers a detailed and modern insight into the roles and nursing practice of this marginalised group of nurses. Although all nurses offer physical nursing care, unique to these nurses is the breadth and depth of social, behavioural, emotional and adaptive behaviour support across the lifespan. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to report on registered nurses' adherence to current Australian health behaviour recommendations. Barriers and facilitators to healthy lifestyles, and their attitudes towards being role models and promoting healthy lifestyles to their patients. Background: It is widely accepted that a healthy diet, limiting alcohol consumption, abstinence from smoking and regular physical exercise are important components of healthy lifestyles and play a significant role in preventing chronic diseases. Nurses are well situated to contribute to providing health and patient education regarding modifiable health risk factors, however their own adherence to health behaviours may impact this. Study design and methods: The research is a mixed methods study of 123 registered nurses from both public and private organisations in regional Queensland. Data for this paper were generated from an online survey which is the first of two phases in the broader study. Results: Four health risk factors were examined; diet, smoking, physical exercise and alcohol consumption. BMI was also calculated and considered as a fifth risk factor. Of this sample, 13% of participants met the guidelines for fruit and vegetable intake, 5.2% smoked, and only 24.2% exercised enough to be classed sufficiently active for their health. Of the 93.62% of participants whom consumed alcohol, 69.3% consumed more than two standard drinks/day. The most common barriers to adhering to healthy lifestyles were shift work, long working hours and family commitments. Conclusion: Many nurses are not adhering to healthy lifestyle recommendations. It is recommended that the health and wellbeing of our health professionals, especially nurses be considered. Providing support and resources to enable them to care for themselves, may in turn allow them to better care for patients. Implications for research, policy, and practice: Research is needed into strategies to enable registered nurses' better work/life balance. To make a real difference to health outcomes, nurses own health and health education needs to be made a priority that is supported and implemented at multiple points: by policymakers, within nursing practice, nursing curriculum, and in healthcare institutions. Nurses need to be supported to provide health education to their patients with better resources, education, and time allocation. Future research should include studies conducted in different regions or ideally a large nationally representative sample. [ABSTRACT FROM AUTHOR]

Objective: This study was carried out to determine the effect of self-management support given to patients diagnosed with hypertension on the hypertension knowledge level, treatment adherence and self-care management, and to examine the changes in patients' blood pressure after the self-management support. Background: The rise of chronic diseases such as hypertension necessitates the equipment of patients with sufficient knowledge and skills necessary to manage their disease and self-care. Methods: This randomised controlled research was conducted with a total of 137 patients, including 69 intervention and 68 control patients. Data were collected using the "Patient Information Form", "Hypertension Knowledge-Level Scale", "Hill-Bone Compliance to High Blood Pressure Therapy Scale" and "Self Care Management Process in Chronic Illness Scale" at the first interview and the last interview three months after the first interview. One week after the first interview, the patients in the intervention group received self-management support including information about hypertension and its management and blood pressure measurement skills. results: After self-management support, a significant improvement was found in hypertension knowledge level (p=0.000), treatment adherence (p=0.000), and self-care management (p=0.000) of patients in the intervention group A significant decrease was determined in systolic (p=0.000) and diastolic blood pressure (p=0.000) of patients in the intervention group. conclusion: Self-management support has shown positive effects in increasing hypertension knowledge level, adherence to hypertension treatment, self-care management, and blood pressure control in patients diagnosed with hypertension. This study also provides nurses with an approach in which they can effectively use training and counselling roles for patients. implications for research, policy, and practice: Patients diagnosed with hypertension should be educated by nurses about the disease. Nurses should teach the patients who are diagnosed with hypertension the ability to monitor their blood pressure at home. Cardiovascular rehabilitation nursing units should be established in hospitals to provide more effective self-management support to hypertensive patients. What is already known about the topic? * Education and support programs offered by nurses are important in controlling chronic diseases such as hypertension. * Guidelines for the management of arterial hypertension emphasise the importance of self-management support in controlling hypertension. What this paper adds * Self-management support is an effective approach to increasing hypertension knowledge level, adherence to treatment, and self-care management. * Self-management support helps patients to achieve blood pressure control and optimal blood pressure values. * Self-management support empowers patients by increasing their control over the disease. [ABSTRACT FROM AUTHOR]

Background: Intensive care nurses look after the most critically ill patient population with the highest mortality rate on a daily basis. Whilst research to date has highlighted and provided some insights into the current provision of end of life care, further research is much needed to improve the efficacy of nurses existing practice. Objective: To investigate the specific barriers and contextual characteristics that nurses experience within the Intensive Care Unit environment. Study Methods: The National Questionnaire of Critical Care Nurses Regarding End of Life Care was used to collect quantitative and qualitative data to answer the research questions. This study was conducted in a major intensive care unit located in a tertiary public hospital in metropolitan Western Australia. Results: The respondent rate was 67.31%. Obstacles with the highest perceived intensity score (PIS) reported by participants involved issues around the communication and practice of end of life care including family interaction. The ranges of mean scores for supportive behaviours were much higher than the ranges for obstacles. These supportive behaviours included allowing family members to have adequate time alone with the patient after death, and families being taught how to engage with the dying patient. Conclusion: The findings reflect that the most intense and frequently occurring obstacles are consistent with past research. A perceived negative end of life care experience by the nurse was found to negatively impact the nurse's psychological and physiological health. The research demonstrates the need for a stronger multidisciplinary patient centred approach. It is envisaged that the findings will support the review and development of appropriate guidelines to support nurses caring for intensive care patients in the initial and progressive phases of end of life care. What is already known about this topic? * ICU patients have the highest incidence of mortality in the acute care setting with one in four patients dying in an ICU, accounting for 15% of all hospital deaths annually. * This patient population presents nurses with a set of unique, yet significant challenges related to increased rate of mortality. * There is a significant amount of existing literature that has explored moral distress amongst nurses, particularly in relation to end of life care. What this paper adds: * This research suggests that there continues to be obstacles that impede critical care nurse's ability to facilitate EOLC in the ICU setting. * The participants of this study highlighted the need for stronger emphasis being placed on decision making processes, communication, and standardised practice. * The most supportive behaviours reported were associated with practice that could be initiated by the nurse such as, allowing family members adequate time with their loved one pre and post death, and teaching family members how to act and engage with their loved ones during this time. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine the relationship between the quality of reflective practice groups and nurses' professional quality of life. Background: Previous nursing research has indicated that reflective practice groups are positively associated with personal resources, job resources, and professional quality of life for nurses. The specific impact of the groups however, has not been distinguished from the impact of personal and job resources, and the explanatory mechanisms for the associations are unclear. Design/Methods: This study utilised a cross-sectional, quantitative research methodology with 184 Australian nurses from a regional teaching hospital who attended reflective practice groups (88.5% female). Surveys captured demographics, personal resources (i.e. self-efficacy), job resources (i.e. job autonomy, skill discretion, job social support, and group cohesion) and perceived quality of reflective practice groups, as measured by the Clinical Supervision Evaluation Questionnaire, alongside professional quality of life outcomes. Results: Participants who rated reflective practice groups as 'high quality' or more effective were associated with significantly higher scores for personal and job resources of self-efficacy, autonomy, skill discretion, social support, and group cohesion. These resources, in turn, correlated with more positive professional quality of life scores; in particular compassion satisfaction and burnout. Discussion: While the study used cross-sectional data and causality cannot be inferred, the findings do indicate a clear association between attending effectively facilitated reflective practice groups and greater personal and job resources. This may indicate that the groups provide nurses with an opportunity to build or enhance these resources. Furthermore, it is proposed that this could explain a mechanism by which reflective practice groups can indirectly impact positively on professional quality of life for nurses by building resources. Future research should explore causality longitudinally. Conclusion: This study provides evidence that nurses who perceive the groups favorably have greater social support, enhanced self-efficacy, more autonomy, and increased skill discretion. These factors also align with the restorative and formative benefits of supervision. Greater personal and job resources, in turn, can enhance professional quality of life. Whilst mediating pathways have been identified, it is still not possible to definitively attribute the development of these resources to group participation. Implications for Research, Policy, and Practice: There is growing evidence to support reflective practice groups as a viable form of group clinical supervision for nurses. It is important to ensure reflective practice groups are effectively facilitated. What is already known about the topic? Correlational data indicates that high quality reflective practice groups may offer a cost-effective form of group clinical supervision, for nurses; providing support and helping them deal with what can be a challenging professional environment. Reflective practice groups have been linked to a range of benefits across individual and organisational levels, including; 1) increased job satisfaction, 2) higher quality of patient care, less critical incidents, 3) higher rates of staff retainment and reduced leave, and 4) enhancing the integrity of the nursing profession through accountability and skill development. What this paper adds Despite these claims, little is known regarding the mechanisms underpinning these documented benefits. This study provides a theoretically driven explanation; that reflective practice groups provide an opportunity for job crafting, in which nurses actively build resources (i.e. skills development critical thinking and social support), mitigating some of the negative psychological consequences associated with nursing. This information can help guide policy, practice, and the development of effective interventions to provide support and supervision for nurses. [ABSTRACT FROM AUTHOR]

Background: Providing healthcare in a remote or rural setting can be complex and difficult, with many remote area nurses not receiving sufficient orientation or preparation. This is particularly important for the management of medicines. Aim: This analysis evaluates an online medicines safety course called Pharmacotherapeutics for Remote Area Nurses. Study Design and Methods: Eight cohorts of students (n=629), between 2016-2020, were included in the evaluation. A mixed methods approach was used to evaluate the impact of the online pharmacotherapeutics course. At the end of each module and at the end of the course participants were asked to complete an online questionnaire. In-depth semi-structured interviews with key stakeholders (n=9) were also conducted, and data thematically analysed. Results: The online pharmacotherapeutics course was well received (average of 4.3 on a 5-point Likert scale). It was easy to navigate (2.6 on a 3-point Likert scale), the flow was logical (2.8 on a 3-point Likert scale) and it was clear how to achieve learning outcomes (2.8 on a 3-point Likert scale). The learning content in each of the modules were well received (4.1-4.5 on a 5-point Likert scale) and deemed appropriate for nurses practicing in the remote areas (2.7-2.9 on a 3-point Likert scale). Thematic analysis of the stakeholder interviews and participant surveys revealed the pharmacotherapeutics course improved knowledge, confidence, and competence of nurses in relation to medicines management and results in better preparedness of the remote health workforce. Key stakeholder feedback highlighted that the pharmacotherapeutics course was seen as an important part of preparing and upskilling the remote health workforce. Discussion: Overall, the pharmacotherapeutics course was well received by nurses and key informants. It improved self-reported knowledge, confidence, competence, and preparedness for nursing practice in remote locations. Conclusion: The continued support of professional development and education for the remote health workforce is vital to ensure optimum patient care. What is already known about this topic? * People in remote Australia generally experience poorer health and face increased challenges in accessing care compared with major city counterparts. * In remote regions, access to healthcare services is reliant on the availability of a competent workforce with nurses forming the backbone of rural and remote primary care. * The use of medications is the most common intervention in healthcare and improvements in the quality use of medicines can have significant benefits to a person's wellbeing. What this paper adds: * Professional development and education for the remote health workforce is vital to ensure optimum patient care. * Education that is appropriate, relevant, and accessible can increase self-assessed knowledge, competence, and confidence in relation to medicines management. * Online education that is developed in collaboration with stakeholders and addresses an identified need is an acceptable and accessible method of providing professional development to the remote health workforce. [ABSTRACT FROM AUTHOR]

Aims: To present the results of a region-wide evaluation of Baby Makes 3, a brief relationship education program for first time parents implemented in the maternal and child health setting. Background: The program is designed to utilise the 'teachable moment' provided by the birth of the first child, and strengthen the couple relationship, promoting gender equity and preventing intimate partner violence. The literature contains only a few similar examples, none of which have been implemented on a region-wide scale in a rural context. Participants: First time parents in the Great South Coast Region of Victoria, irrespective of whether they had participated in Baby Makes 3, group facilitators, and other stakeholders involved in the program across the region including maternal and child health nurses. Methods: Interviews were conducted with parents, group facilitators and other stakeholders. Routinely collected surveys completed by parents and group facilitators were also analysed. Data was collected throughout the period April 2013 to August 2015. Findings: Fewer than one-third of new parents in the region participated in Baby Makes 3. Parents, group facilitators and other stakeholders all made suggestions as to how program reach could be improved. These included the need to take account of key components of rural life including farm work and not clashing with sporting activities. Nevertheless, for those who participated, the program was judged highly effective according to both parents and staff. Additionally, parents valued the social interaction generated by the program as an outcome in itself, connected to the value of the program in normalising the challenges they were facing as new parents. Minimal negative effects were identified. Discussion: Transition to parenthood is a time when many parents are open to exploring gender roles and expectations within their relationships, especially in a context in which the challenges of parenting are normalised. However, the implementation of such a program which has been designed in an urban context may require modifications when delivered in a rural area. Conclusion: Parenting programs are just as necessary in rural as in urban contexts. Furthermore, modifying the program to commence prior to the birth of a child further work may improve program reach. What is already known about this topic? * The birth of the first child, has been found in urban settings, to be a time when parents are open to brief interventions which lead to improved awareness, communication skills, attitudes and behaviours supportive of gender equity and a strengthened couple relationship. What this paper adds: * Programs which promote gender equity and respectful relationships are beneficial to new parents in rural areas, but effective implementation requires taking into account the characteristics of local communities. [ABSTRACT FROM AUTHOR]

Objective: To obtain Australian nurses' perspectives regarding COVID-19 preparedness early in the pandemic. Background: In March 2020 Australia experienced a rise in COVID-19 cases and was bracing itself for the worst, having witnessed China, Europe and America's earlier exposure to the outbreak. On 14 March 2020 an Australian nurse set up a Facebook page called "Nursing in the time of COVID-19: A clinical forum" allowing colleagues to share information about COVID-19. This presented an ideal opportunity to survey nurses' preparedness for the pandemic. Study design and methods: Anonymous web-based survey disseminated between 9 April--4 May 2020 via the Facebook page. Results: A total of 214 nurses responded to the survey of whom 85% were direct care clinical staff and 29 (13.5%) had cared for a COVID-19 patient. Prevalent feelings regarding COVID-19 were anxious, overwhelmed, vulnerable, engaged and interested. The strongest sources of information regarding COVID-19 were published academic articles, WHO/ CDC and similar authorities, employer leaflets/ guidance and Facebook. The strongest needs/ expectations identified by the respondents were education and information, access to mental health counselling, provision of additional health workers to support nurses, and supplemental pay rise. Respondents identified work-related training specific to COVID-19, revision of skills and competencies and upskilling to do tasks previously not familiar to the participant of particular benefit. Nurses who had cared for COVID-19 patients expressed a stronger interest in receiving a supplemental pay rise for risk exposure, a stronger sense that they and their employer were ready to care for COVID-19 patients yet expressed less appreciation for mental health counselling compared to nurses who had not yet cared for COVID-19 patients. Discussion: The perspectives of Australian nurses are generally similar to nurses in other countries. However, we report some variations between nurses who have and have not cared for COVID-19 patients. We identify the levels of concern as well as those supportive actions that are most appreciated by nurses responding to COVID-19 specifically, these same findings could be applied to other major events generally. Conclusion: The timing of this survey allowed us to explore the perspectives of Australian nurses during the early pandemic vulnerability period without the benefit of hindsight. Despite thinking the Australian experience was going to be worse than it was, Australian nurses showed relative confidence in their own and their employers' readiness and this was most obvious in nurses who had cared for COVID-19 patients. What is already known about the topic? • Nurses around the world have voiced anxiety and concern about the COVID-19 pandemic and the impact it may have on them personally and professionally. • Nurses have access to informal networks, social media, media, employer guidelines and other professional and academic sources of information to stay informed and up-to-date with current information on COVID-19 that may help to allay their concerns. What this paper adds • The perspectives of Australian nurses early in the development of the COVID-19 pandemic in relation to how prepared they felt at the time and where they were obtaining information to help guide their thinking and their practice. • A synopsis of the role and benefits of a social media platform to allow nurses to share thoughts, articles of interest and experiences of COVID-19. • Opinions vary based on whether a nurse had already cared for a COVID-19 patient or not. [ABSTRACT FROM AUTHOR]

Objectives: To examine in a sample of nurses working in acute-care wards, self-reported perceptions of the: 1) patient; family; nurse; doctor; and health system-related barriers to the provision of optimal end-of-life care to people who are dying in hospital; and 2) five barriers which, if removed, would lead to the greatest improvements in hospital-based end-of-life care. Background: Nurses play a central role in caring for dying patients and can offer a unique perspective about the factors that impact the quality of end-oflife care delivered in hospitals. Study design and methods: Two hundred and fifteen registered and enrolled nurses from three metropolitan and three rural hospitals across three health services completed a questionnaire-based, cross-sectional study between April 2016 and June 2017. Results: Nurses perceive that doctors continue to treat for too long (79% ranked as a large barrier); families have unrealistic expectations about a patient's prognosis (73%); junior doctors are unwilling to alter the decision of senior doctors (67%); doctors do not adequately explain the dying process (66%); and doctors have inadequate training in end-of-life care (66%). Nurses indicated that doctors reducing the length of active treatment and families having a more realistic expectation about life-expectancy would lead to the greatest improvement in end-oflife care in hospitals. Discussion: In this study of nurses working in a wide range of acute care settings across rural and metropolitan locations, substantial barriers to the provision of high-quality end-of-life care were perceived across all facets of healthcare provision. Important barriers included the continuation of potentially futile treatment, inadequacy of symptom control, and poor communication between doctors, patients and their families. Conclusion: Nurses perceive a range of patient; family; provider; and health system-related challenges to the provision of optimal end-of-life care in hospital. Findings highlight potential areas for improvement as part of a coordinated approach to optimising the provision of end-of-life care in hospitals. Future goals should include larger-scale, longitudinal studies across various states and territories to inform the development of interventions that can help to address the identified gaps in service provision. Implications for research, policy, and practice: This study has highlighted the need to involve all stakeholders when designing interventions to improve end-of-life care. Nurses can provide valuable insight into the factors that can make the greatest impact in improving care provision. It suggests that the provision of high-quality end-oflife care in hospitals is complex, and that there is substantial overlap between items nurses perceive to be barriers in each of the five domains of care provision. To achieve sustainable improvement in the quality of end-of-life care provided in hospitals, a multi-factorial, and collegial, approach to designing interventions will be needed. What is already known about the topic? • End-of-life care is increasingly being provided in hospital settings. • Nurses are an important source of information and support for dying patients and their families. • Few studies have explored nurses' perceptions of the barriers to the provision of high-quality end-oflife care across all domains of healthcare provision. What this paper adds: • Important barriers include continuation of potentially futile treatment, adequacy of symptom control, and poor communication between doctors, patients, and their families. • Findings can support the design of more effective intervention strategies to mitigate identified barriers and achieve improvements in the quality of end-of-life care delivered in hospital. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effects of a communitybased chronic heart failure management program, delivered by nurse practitioners, on self-care behaviour, quality of life and hospital readmissions. Background: Chronic heart failure is a complex condition associated with high rates of hospital readmissions. However, many hospitalisations in patients with chronic heart failure are potentially preventable with better self-management and access to specialised healthcare support. Nurse practitioners have an advanced scope of practice, making them well credentialed to support patients with chronic heart failure. Study design and methods: This study compared self-care behaviour and quality of life in patients who had attended a nurse-practitioner led chronic heart failure management service (SmartHeart) (n=58) compared with patients receiving usual care (n=58), but no nurse practitioner support. Self-care behaviour was assessed using the Self Care Heart Failure Index and quality of life was assessed using the Short Form-36 and Minnesota Living with Heart Failure Questionnaire. Hospitalisation records were extracted from medical records using data-linkage. Results: Patients who received nurse-practitioner support had better self-care behaviour (p<0.05), mental component summary of the Short Form-36 (p<0.05) and heart failure specific quality of life (p<0.05). All-cause hospitalisations were delayed (p<0.05) and length of stay was shorter (p<0.05) in the group receiving nurse practitioner support, but there were no differences in chronic heart failure related admissions. Discussion: A chronic heart failure support program, operating in a community setting and delivered by nurse practitioners, enhanced self-care, improved psychosocial health and reduced time in hospital. Conclusion: Chronic heart failure management delivered by nurse practitioners can improve self-care behaviour and quality of life, and reduced hospital admissions, compared with usual care. What is already known about the topic? • Chronic heart failure is a complex health issue requiring disease-specific management that needs to be tailored to the individual. However, many patients with chronic heart failure don't receive adequate support to manage their condition. What does this paper add: • A chronic heart failure management service, delivered in primary care by nurse practitioners, improved self-management and quality of life and was associated with a lower rate of hospitalisations compared with usual care alone. [ABSTRACT FROM AUTHOR]

Background An understanding of anatomy, physiology and pathophysiology is considered essential for graduate nurses, but many nursing students find such courses difficult and anxiety-provoking. This was contrary to the authors' experiences, so student perceptions were studied at the survey institution. Objective This paper examines nursing students' satisfaction with bioscience and nursing courses in the first two years of a Bachelor of Nursing at an Australian university, in order to suggest strategies for effective bioscience teaching. Design Quantitative data for student satisfaction, measured on the Likert scale, were collected for three bioscience and 11 nursing courses from 2010 - 2012. Mean satisfaction was compared among courses and offerings by ANOVA, with offerings nested within courses, and correlation analysis was used to examine the relationship between student satisfaction and pass rate. Qualitative data were sourced from open questions, emails and forum posts and examined for recurrent themes. Results Students rated the three bioscience courses in the top four of the 14 courses. There was no relationship between satisfaction and pass rate. Qualitative responses showed satisfaction with the course content, the learning materials, the delivery style and lecturer support. Conclusion It is possible to deliver bioscience courses that are appreciated by nursing students. Four principles are suggested in this paper that may improve student satisfaction with bioscience courses and, therefore, result in more effective learning and better prepared nursing graduates. [ABSTRACT FROM AUTHOR]

Objective: This study represents phase one of a three-year research project aiming to investigate the impact of reflective practice groups for nurses. Background: Evidence indicates that increased job demands, and inadequate support contribute to nursing burnout, reduced capacity and workplace attrition. There is some evidence that group interventions may help address such issues. Study Design/Methods: This study utilised a cross- sectional, quantitative research methodology. Overall, 251 nurses completed questionnaires incorporating 11 validated subscales. Levels of compassion satisfaction, intolerance to uncertainty, inhibitory anxiety, group cohesiveness, psychological distress, and psychosocial safety were evaluated in relation to number of groups attended, for both individual nurses and work groups. The data was then examined alongside existing personal and job resources. Results: Individual nurses who attended 6-18 reflective practice groups demonstrated increased tolerance to uncertainty and less inhibitory anxiety, whilst those who attended more than 18 groups demonstrated increased compassion satisfaction and group cohesiveness. There was, however, no evidence to indicate more pervasive, work group benefits. Whilst the second part of the study confirmed that reflective practice group attendance was significantly correlated with increased compassion satisfaction, it was not able to explain changes in levels of burnout, secondary traumatic stress or compassion satisfaction over and above personal factors, job factors and levels of psychological distress. Conclusion: Professional quality of life involves a complex set of variables. Reflective practice group attendance is correlated with a number of benefits for nurses however cause and effect were not clearly determined. A subsequent study will focus on the more subtle mechanisms and indirect effects of the groups on nurses' personal resources. Relevance: This research supports the role of person and job factors in explaining professional quality of life for nurses and provides evidence to support a number of positive outcomes for nurses attending reflective practice groups; establishing a foundation for future studies to explore impacts and mediators in greater detail. What is already known about the topic? * Personal and job resources can buffer against job demands to improve Professional Quality of Life (ProQoL). * Nurses who lack personal resources are more likely to report burnout. What this paper adds: * Personal resources of autonomy, self-efficacy and optimism are particularly important for nursing ProQoL. * Higher levels of RPG attendance are correlated with improved tolerance to uncertainty, reduced inhibitory anxiety, increased compassion satisfaction and improved group cohesion. * An explanatory link between RPG and variations in ProQoL is still not clear as RPG attendance in itself was not found to account for changes in ProQoL over personal resources, job resources and job demands. * The study identifies a direction for further research into the role RPG may play in the development of personal resources for nurses. [ABSTRACT FROM AUTHOR]

Objective: To examine if a perinatal breastfeeding program would improve the exclusive breastfeeding rate at a baby-friendly hospital. Background: The Ten Steps to Successful Breastfeeding and Baby-Friendly Hospital Initiative have been widely used to improve breastfeeding outcomes worldwide. A hospital-based multi-strategy intervention may provide an opportunity to increase breastfeeding in different countries. Study design and methods: The study used a quasi-experimental design. Data was collected in a Baby Friendly hospital. A total of 60 mother-infant dyads were included. The experimental group took part in the multi-component perinatal breastfeeding program, while the control group received routine care. The multi-strategy program included prenatal breastfeeding education, birth kangaroo mother care (skin-to-skin contact and non-separation practices) at first breastfeed, continuous 24-hour rooming-in, ongoing kangaroo mother care with breastfeeding on cue, and hospital support visits. The exclusive breastfeeding rate was measured at hospital discharge, and one-month postpartum. Results: The mothers who participated in the intervention had a greater exclusive breastfeeding rate at hospital discharge and one month postpartum than those in the control group. In the experimental group, 90% of the infants completed the first feeding within two hours after birth. At discharge, 93.3% of the mothers in the experimental group and 53.3% in the control group were exclusively breastfeeding. At one month postpartum, 83.3% of the mothers in the experimental group and 36.7% in the control group were still exclusively breastfeeding. Discussion: The intervention program used in the current study is different to previous studies. The current intervention not only included prenatal education and postpartum support, but also included birth kangaroo mother care at first breastfeed and ongoing kangaroo mother care with breastfeeding on cue. Breastfeeding should be promoted through perinatal comprehensive clinical and social support starting in the prenatal period and continuing through intrapartal, postpartum, and follow-up periods. Conclusion: This study was the first study to use a hospital-based multi-strategy intervention including the non-separation of mother-infant dyads and other breastfeeding support for mothers in Taiwan. The program was associated with a significant improvement in the exclusive breastfeeding rate at one month postpartum. Implication for practice: This study provided initial evidence to support the implementation of mother-infant non-separation practices in improving breastfeeding outcomes. Health professionals can be re-educated regarding birth kangaroo mother care at first breastfeed and ongoing kangaroo mother care with breastfeeding on cue without increasing nursing workloads while infants' fathers and other family members (eg. mothers-in-law/mothers' mothers) can be encouraged to participate in order to achieve family-centred maternity care. What is already known about the topic? * Early and exclusive breast feeding and ongoing breast feeding is the optimal form of nutrition for newborn babies and promotes positive infant and mother outcomes. * Birth kangaroo mother care plays an important role in providing the optimal atmosphere for a baby's instinctive reflex ability to breastfeed effectively in order to help infant imprinting and suckling. What this paper adds: * The newly developed hospital-based perinatal breastfeeding program has demonstrated effectiveness in promoting exclusive breastfeeding rate at one month postpartum. * Including birth kangaroo mother care at first breastfeed and ongoing kangaroo mother care with breastfeeding on cue in a perinatal breastfeeding program may lead to more positive breastfeeding experiences for new mothers. [ABSTRACT FROM AUTHOR]

Aim: To review, test and refine standardised tools for nurses to initiate treatment summaries and care plans, and identify barriers and enablers to providing them. Background: This paper reports on a pilot study informed by the development of a Survivorship Framework in South Australia. Methods: Expression of interest was sought for adult medical oncology services to pilot standardised tools within existing services and resources. A quality improvement approach was used over three months with nurse practitioners and nurse practitioner candidates to obtain feedback, refine tools and resources, and identify barriers and enablers. Quantitative and qualitative data was recorded at each site using spreadsheets, at fortnightly meetings, and at a final debriefing. Content analysis was used to identify key themes in the context of barriers and enablers. Findings: Four medical oncology clinics in South Australia participated (three metropolitan, one regional). Forty-three consultations were delivered at three sites. Barriers included time to complete documentation, perceived knowledge and skills, re-orientation of clinics and referral pathways, competing service priorities and lack of administrative support. Enablers included interrelationships within and between pilot teams, supporting resources, and increased familiarity with tools. Discussion and conclusion: There is potential for nurses to initiate treatment summaries and care plans in the treatment setting with the use of standardised tools. Further refinements are needed to make the process less time burdensome, additional specialised training is needed to improve confidence of nurses to work in a wellness model, and numerous system challenges need to be overcome to improve overall feasibility of using standardised tools to provide survivorship support to patients. Lack of systems to populate information, and lack of referral processes to support survivorship discussions with patients are likely to limit the initiation of survivorship care in treatment settings in South Australia. Further nurse-led development of tools for treatment summaries and care plans should occur in parallel with translational research designed to address system challenges. [ABSTRACT FROM AUTHOR]

Objectives To investigate the impact of the introduction of The Productive Ward Program™ on two patient safety indicators; patient falls and medication errors. Design Retrospective quantitative study. Setting The study was conducted at a major metropolitan acute care hospital in Sydney, Australia. Subjects This study was conducted in a medical, surgical and two aged care wards, with a combined total of 120 inpatient beds over a 32 month time period. Main Outcome Measures The number of patient falls and medication errors for each of the participating wards. Results The implementation of The Productive Ward Program™, did not have an overall significant statistical reduction in the number of falls and medication incidents. Aged Care 1, had a reduction of 13 falls between intervention and post intervention phase, these results were not statistically significant (OR 1.17; 95% CI 0.86, 1.59). For Aged Care 1 ward there was a statistically significant reduction in medication errors from 66 errors pre intervention to 27 medication errors post intervention (OR 2.73;95% CI 1.71, 4.38). Conclusion The results of this small study indicate that the implementation of The Productive Ward Program™, did not have an overall significant statistical reduction in the number of falls and medication errors. This paper highlights the need for future research on the impact of the Productive Ward Program on patient safety. [ABSTRACT FROM AUTHOR]

Objective This paper reports on a major category that emerged as a result of a Grounded Theory study that explored Registered Nurses' (RN) understanding of the nursing standard requirement to provide nursing students with professional development during their clinical placements. Design Grounded Theory study. Setting Nursing clinical education. Subjects Fifteen registered nurses participated in this study (n=15). Thirteen were female and two were male. Main outcome measures In-depth semi-structured interviews were the means of data collection. Constant comparative method was used to analyse data. Results The notion of choice emerged as a major finding. Choice is conceptualised as choosing whether or not to be involved in the professional development of nursing students. The category choice is informed by two themes; unsuited to teaching, and respecting peers. Conclusion According to the Australian nursing standards RNs are responsible for providing professional development to nursing students on clinical placements. Results from this Grounded Theory study revealed that participants perceived it is an RNs choice whether or not to provide professional development to nursing students. [ABSTRACT FROM AUTHOR]

Objective Given that the current shortage of nurses threatens the quality of health care globally, we urgently need to find new ways to bolster recruitment. This paper aims to understand patterns and predictors of interest in a nursing career among school students in order to inform ways of ensuring a viable future workforce. Design A four-year longitudinal mixed methods study undertaken in New South Wales, Australia. Setting and subjects Survey data collected annually (2012-2015), involving 6,492 students in Years 3-12 in government schools, were analysed using logistic regression. Focus group data (2013-2015) involving 553 students and open-ended survey responses were analysed to investigate reasons for interest in nursing. Results Significant predictors of interest in nursing included being female and having a parent in a nursing occupation. A 'helping orientation' and prior experiences with nurses or nursing were key factors underpinning students' interest in this career. Some students perceived nursing as a 'safe' career choice, balancing practical concerns, such as job security, with their desire to care. Other students expressed ambivalence, with nursing but one of many 'caring' careers to which they were drawn. Conclusion Given that early experiences with nursing or nursing-related activities influenced the desire to pursue this career, developing new experiential strategies that engage school student interest are important for ensuring the growth and stability of the Australian nursing workforce. [ABSTRACT FROM AUTHOR]

Objective The main aim of this study was to explore any association between colorectal cancer (CRC) and rotating shift work in nurses and midwives. The secondary aim of this study was to identify risk factors for CRC in nurses and midwives who are rotating shift workers. Design Cross-sectional study. Setting Electronic survey of participants from Australia, New Zealand and the United Kingdom. Subjects A sample of 8,199 male and female nurses and midwives from Australia, New Zealand and the United Kingdom invited through their registration papers or newsletter advertisement. Main outcome measure Prevalence of CRC in participants who have worked rotating shifts for 1-14 years or ≥15 years compared to participants who have never worked rotating shifts. In addition, risk factors for CRC in the rotating shift work population were analysed in a multivariate logistic regression model in order to obtain odds ratio of CRC. Results No statistically significant difference was found in the prevalence of CRC between those who have never worked rotating shift work, worked 1-14 years and worked 15 or more years. Among rotating shift workers, diabetes was associated with a 123-fold (95% CI 39-392; p<0.001) increased odds of CRC, while Inflammatory Bowel Disease (IBD) was associated with a 190-fold (95%CI 68-526; p<0.001) increased odds of CRC. Screening colonoscopy or sigmoidoscopy for CRC was associated with a 10-fold (95% CI 3-35; p<0.001) increased odds of being diagnosed with CRC. Conclusion No significant association was found between rotating shift work and colorectal cancer in nurses and midwives. In nurses and midwives who are rotating shift workers, diabetes, IBD and CRC screening significantly increased the odds of CRC. [ABSTRACT FROM AUTHOR]