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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: To identify self-reported influences and drawbacks for early career nurses to work in a rural location. Background: The international shortage of rural nursing workforce is increasing. As a result, evidence that focuses on mechanisms to recruit early career nurses to these areas is important. This research focuses on the influences and drawbacks for early career nurses to undertake a rural graduate nursing program, aimed at providing evidence that can inform the design of rural nurse recruitment programs. Study design and methods: Manifest content analysis of open-ended questions in a cross- sectional survey that was administered in two rural Local Health Districts (LHDs) in New South Wales, Australia. Early career nurses commencing employment in either of the research locations in 2019 and 2020 were eligible to complete the survey. In two open-text questions, respondents were asked to respectively describe what the most influential factor was in their decision to commence employment in their location, and what were the drawbacks of this location, if any. Results: Of the 175 early career nurses invited to complete the survey, 165 (94.29%) returned a completed survey. Four themes were identified as influencing rural early career nurse employment; proximity to social and/or familial ties, being attracted to rural clinical practice, taking advantage of a job offer in a limited market, and wanting a rural lifestyle. Where drawbacks were described, themes referred to distance from social and/or familial ties, rural lifestyle factors, resource challenges, and a perception of less professional opportunity. Discussion: There may be an opportunity to attract and retain rural nurses through targeted social initiatives and creating community ties, particularly among those early career nurses who have no close friends and family nearby. This reflects other literature and the growing understanding of the importance of social connection, familial ties and life course in early career nurse decision making. Conclusion: The results of this research demonstrate that proximity to social and/or familial ties is both the biggest influence and drawback for early career nurses to accept employment in a rural location. Implications for research, policy, and practice: Strategies that capitalise on practical ways to integrate social connection and life course approaches in early career nurse onboarding in rural areas should be explored in future research with a view to creating guidance for rural health organisations and policy makers. What is already known about the topic? • Australia is facing a significant and growing deficit in the number of nurses choosing to practice rurally. • Rural origin and rural placements influence rural practice intention. • Early career nurse programs are an initiative aimed to support the transition of nurses into practice from undergraduate study and can act as a pathway for nurses to enter rural careers. What this paper adds: • Family and social ties are the most influential reasons for choosing a rural location for early career nurses. • Commensurate with this is the greatest drawback for choosing a rural location for early career employment was being away from family and/or friends. • Future research should explore practical strategies that capitalise on the importance of social connections, familial ties, and life course for rural nurse career decisions. [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: Study 5, from a series of six, examines the influence of attendance rates and personal attendance preferences on the effectiveness of Reflective Practice Groups (RPGs). It also explores participant perceptions regarding benefits and barriers of RPG. This article presents the current study in context of associated research and attempts to synthesise the collective findings. Background: Nursing can be associated with burnout, secondary traumatic stress (STS) and compassion fatigue. RPGs might help mitigate these negative impacts. Study Design/Methods: This cross-sectional study surveyed a cohort of 190 nurses (88% female) using validated scales to assess professional quality of life (ProQOL), job satisfaction (JS) and psychological distress, alongside perceived effectiveness of RPG, attendance rates and preferences. Open-ended questions explored perceived barriers and benefits to attendance. Results: Nurses who attended less RPGs reported higher STS. Those who preferred to go more frequently also reported higher STS however level of attendance and personal preference did not affect each other. Nurses attending 'as often as groups are run' also rated the effectiveness of RPG more highly. Other outcome measures were not significant for either variable. Perceived benefits of RPG included sharing, support, cohesiveness, skills development and facilitatory alliance. Barriers included workloads, rostering, time constraints and discomfort in a group setting. Discussion: The majority of nurses reported higher STS, preferred to attend RPGs more frequently, and rated them as more effective. Nurses who attended more RPGs reported significantly lower STS, indicating a restorative benefit. The lack of significance for Compassion Satisfaction (CS) ratings contrasted with findings of earlier studies. Logistical issues and discomfort in groups were barriers to RPG attendance. Perceived benefits related to personal and workgroup development. Alongside findings from the overarching project, results indicate a positive correlation between effective RPGs, personal and job resources, and aspects of ProQOL. Conclusion: Nurses with higher STS find RPGs more useful and want to attend more often. Higher RPG attendance is associated with lower STS. Voluntary attendance, facilitatory alliance, promotion of psychological safety, and organisational support are key considerations. In context of the overarching project, RPG attendance has been positively correlated with various aspects of ProQOL, personal and job resources. Cause and effect are still not clear and further research is required. What is already known about the topic? * RPGs are positively correlated with personal and job resources and CS. * Barriers to reflecting in RPGs include workplace logistical issues. What this paper adds: * Greater RPG attendance is associated with lower STS. * Nurses with higher STS prefer to attend more often and find RPGs more useful. * Discomfort in a group setting is an important consideration and should be addressed through effective facilitation and management of group process to promote psychological safety. * RPGs have now been positively associated with a greater number of personal resources, job resources and aspects ProQOL. [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 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]

This study explored personal hygiene options of renal patients that maintain the integrity of central venous catheter exit site dressings between dialysis sessions. Background: Infection is a major life-limiting risk for patients undergoing haemodialysis via a central venous catheter. Meticulous attention to keeping the exit site dressings clean and dry is an essential defence in preventing local and systemic infections. It is difficult to maintain the integrity of water-resistant dressings in tropical environments. Study Design: A three-phase exploratory study was conducted in a northern Australian Renal Service. Methods: Phase 1 employed a cross-sectional, anonymous, online survey of renal nurses about the acceptability and feasibility of two hygiene options for patients: bathing wipes and a waterproof dressing cover. The survey also canvassed their concerns about the options. Descriptive statistics were used to summarise Likert-scale responses and content analysis was used for responses to open-ended survey questions. Phase 2 used conversational-style interviews with patients about their hygiene preferences, how they endeavoured to keep their dressings dry, and their impressions regarding the proposed options. Phase 3 was a series of case studies of patients trialling the provided options over a six-week period. Participants were progressively recruited to this phase and were provided with the product/s of their choice at each dialysis session; renal nurses also assessed the integrity of the dressings at each dialysis session. Research nurses discussed with the participants their experiences with the options. Results: Phase 1: Nurses (N=37, response rate 58.7%) considered both options acceptable and feasible for patients, noting some practical concerns related to their use. Phase 2: Patients (N=27, 100% participation rate) described hygiene preferences and difficulties they encountered with keeping dressings dry. Only one participant had a bath, as per written advice. All were enthusiastic about trying the proposed options. Phase 3: Patients (N=22) appreciated being able to shower without wetting their exit site dressings. Individuals were inventive in modifying the application and use of the waterproof cover according to their body shape and the central venous catheter exit site location. Although participants liked both options, the waterproof covering was most popular and most frequently used. Intactness of the dressings was 83% during the trial; there were no central venous catheter-associated infections during the study. Conclusion: Self-management and choice were motivating factors for participants. Patients embraced being able to keep their dressings dry and intact during personal hygiene in a tropical environment. Implications for research, policy, and practice: Patients demonstrated their willingness to undertake a more active role in their dressing care, while exercising choice with respect to personal hygiene. Studies that further increase patients' participation in other aspects of their self-care warrant further investigation. The organisation is pursuing options for the ongoing provision of the products used in this study and how their use can be monitored in clinical practice. What is already known about the topic? * Intact dressings provide an important line of defence against infection in the vulnerable population of patients receiving dialysis via central lines. * Hygiene needs are also an important consideration for quality of life, empowerment, and autonomy. * Patients' current attempts to meet their own hygiene needs often result in a disruption to the intactness of the dressing site and predispose them to systemic infections. What this paper adds * This study facilitated exploration of two feasible hygiene options in an open and culturally safe manner, from both patients' and nurses' perspectives. * The opportunity to perform personal hygiene according to individual preferences resulted in a willingness of participants to undertake a more active role in the care of their dressing. * The identification of two acceptable and feasible personal hygiene options has the potential of removing one of the many lifestyle modifications faced by people who undergo haemodialysis via a central venous catheter. [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]

Aim: The aim of this study was to understand the challenges that nurses and midwives face when seeking to practice social distancing within the various clinical settings in a hospital work environment during COVID-19. Background: COVID-19 has had a significant impact on nurses and midwives internationally. With the ease of transmission of COVID-19 and the limitations in pharmaceutical interventions, other measures had to be implemented across communities and in healthcare settings. These public health measures were enacted in various ways throughout the world. A key measure employed globally was social distancing. Australia was no different, initiating community wide interventions to apply social distancing principles and action, in an effort to reduce transmission. Whilst at their places of work, nurses and midwives were also encouraged to practice social distancing. Design and methods: Using convenience sampling, 579 nurses and midwives employed within one local health district in NSW, Australia completed an online questionnaire during the COVID-19 pandemic. Subsequently, a thematic analysis was undertaken as a way of categorising data from the 216 (37%) qualitative responses with regards to social distancing. This study adhered to The Standards for Reporting Qualitative Research (SRQR) guidelines. Results: Overwhelmingly, responses indicated that participants found it challenging to practice social distancing in their workplaces across various clinical settings within the hospital. The two major themes identified were: 1) challenges relating to social distancing with patients and 2) challenges related to social distancing with colleagues. Several sub themes were also identified. Conclusion: The COVID-19 pandemic has highlighted a number of challenges for healthcare professionals, social distancing being a key challenge. Social distancing is argued to be almost impossible in various clinical settings within a hospital where patient contact and provision of care in a team environment occurs. What is already known about the topic? * Social distancing has been demonstrated as an effective public health intervention to prevent the spread of infectious diseases, such as MERS, SARS and Ebola. What this paper adds: * During COVID-19, social distancing practices in acute healthcare environments have been enforced. However, this creates difficulties for health professionals such as nurses and midwives when providing quality care. * The results showed that social distancing has been more difficult than anticipated to adhere to in the work environment.* The built environment of hospitals (physical layout) and working in multidisciplinary teams made social distancing particularly challenging for nurses and midwives. [ABSTRACT FROM AUTHOR]

Objective: To explore mental well-being and future career intentions of new graduate nurses and midwives (NGs) in their first year of work. Background: Mental well-being is important for people to feel good and function well in their daily life. However, little is known about changes in mental well-being and future workforce intentions of nurses and midwives in their first year of professional practice. Study design and methods: A cross-sectional study was conducted at a large Local Health District in New South Wales, Australia. Nurses and midwives (N=170) who commenced a transition program in February 2017 were invited to complete a survey using the Warwick-Edinburgh Mental Well-being Scale after four to six weeks (Group 1) and again at 10-11 months (Group 2). Unpaired t-tests for independent samples were used to compare differences between time-points. Results: Response rates were 47% for Group 1 and 29% for Group 2. The mean (median) mental well-being score was 52.1 (52) for Group 1 and 48.7 (50) for Group 2. While the majority of respondents retained a moderate/high sense of well-being, decreases were significant for the items, 'feel relaxed' and 'interested in new things'. Being located in rural areas, being aged between 20-29 years and being female was related to a lower well-being score for Group 2. The main factors contributing to NGs well- being were: a supportive environment, resilience, self-efficacy, and sense of achievement. Respondents with higher total well-being scores were significantly more likely to continue working at the current organisations and significantly less likely to seek employment in other organisations. Discussion: This study provides valuable insight into the mental well-being and future career intentions of new graduate nurses and midwives. Most of them retain a moderate to high sense of well-being over their first year of practice which suggests sufficient support is provided, or that they are an inherently resilient population. Building supportive environments that assist resilience, self-efficacy and sense of achievement is critical. Conclusion: With the current COVID pandemic situation, addressing factors impacting on the mental well-being and future career intentions of new graduate nurses and midwives in their first year may be more critical to enhance job satisfaction, leading to improved workforce resilience and capability and therefore the provision of quality healthcare. Implications for research, policy and practice: The findings of the study reinforce the importance of mental well-being to retain new graduate nurses and midwives in the future workforce. What is already known about the topic? * Positive mental well-being supports people to feel good and function well. * Entering into a new workforce as a novice practitioner is stressful and maintaining positive mental well-being in the workplace enhances the capacity to provide safe quality healthcare. * Little is known about changes in mental well-being and future workforce intentions of new graduate nurses and midwives (NGs) in their first year of professional practice. What this paper adds? * Findings show that the majority of NGs retained a moderate/high sense of well-being throughout their first year of their professional life. * Providing a supportive environment, increasing resilience, self-efficacy and sense of achievement will enhance maintenance of positive mental well-being and retention of NGs in the workforce. [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]

Aim: This study aimed to assess the level of knowledge and practice of intramuscular injection among nurses and nursing assistants in primary healthcare. Background: Evidence-based guidelines recommend the use of the ventrogluteal site for intramuscular injection; however, it remains infrequently utilised by nurses. Study design and methods: Cross-sectional study was conducted using a convenience sample of 200 nurses and nursing assistants employed in one of the largest healthcare centres on the primary healthcare level in Slovenia. The data were collected using a self-reported questionnaire and analysed using descriptive and inferential statistics. Results: The majority of the participants (88.5%) prefer to use the dorsogluteal site for intramuscular injections, while the ventrogluteal site is commonly used only by 7.5% of the respondents. Participants avoid the ventrogluteal site because of not being used to it (30.5%), unfamiliarity (27.0%), lack of adequate knowledge (19.5%), fear of harming the patient (8.5%), and not knowing how to determine the site (10.3%). Conclusion: Nursing staffs knowledge and use of ventrogluteal site for intramuscular injection is limited and are using traditional methods instead of current evidence-based guidelines. Implications: Improvements are needed in nursing education and continuous training. The nurse administrators in clinical practice should increase awareness of the benefits of using evidencebased practice and re-evaluate how the nursing professionals provide the administration of intramuscular injections and the need for additional education. The education and training about intramuscular injections should be implemented regularly in daily clinical practice of nursing professionals for promoting the safest practice for patients. What is already known about the topic? • The administration of intramuscular injections is a commonly performed nursing intervention in clinical practice. • The technique for delivering intramuscular injection is associated with potential safety risks for the patient when it is not done according to evidencebased guidelines and safe practices. • The use of ventrogluteal muscle has been recommended in nursing literature for many years now, but nurses still use it infrequently and prefer to use the dorsogluteal site. What this paper adds: • Despite being both legally permitted to administer intramuscular injection, nurses and nursing assistants demonstrated different levels of knowledge and the use of evidence-based recommendations about intramuscular injection administration. • Nurses avoid using the ventrogluteal side due to lack of knowledge and skills. • Stronger emphasis on raising awareness about the importance of using evidence-based practices during nursing education and continuous training is needed. [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: 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: 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 investigate if the current onboarding process influences the organisational socialisation of new graduate nurses and midwives into the workforce. Background: Positive organisational socialisation experience for new graduate nurses and midwives during their entry into the healthcare environment is an important contributor when building an organisation's ability to increase workforce capacity. However, few studies have investigated the onboarding processes to promote their organisational socialisation. Study design and methods: A quantitative, descriptive, cross-sectional study design was conducted at a large Local Health District that provides health services to almost one million people in metropolitan, rural and remote locations. Participants were 170 new graduate nurses and midwives who commenced their transition program at 21 acute and community healthcare settings within the District in January and February 2017. Data was collected through a document review of current onboarding processes and by an online survey of new graduates. Data sets were analysed using descriptive statistics and content analysis. Results: The survey response rate was 47% (n= 80). Findings highlight that the onboarding process provided by the District was useful for the new graduate's transition into the workplace. The findings also indicated that the onboarding process was inconsistent across different contexts in the District and required more relevant and practical components. In addition, the current onboarding did not adequately provide strategies to build relationships for new graduates within their work environments. Discussion: This study provides valuable insight into current onboarding practices in both metropolitan and rural contexts and highlights gaps in this process across the health District. The findings of the study provide insights and future direction for improvements by addressing the inconsistency in the structure and content of orientation programs. The need for more accessible and consistent organisational information and a more structured framework for the organisational wide onboarding process was also identified. Conclusion: Re-design of an onboarding process that is relevant, consistent and enhances relationship-building is imperative to meeting both the professional and organisational needs of new graduate nurses and midwives. Implications for research, policy and practice: The findings of the study imply a need to streamline the onboarding process to provide greater opportunity for new graduates to develop and sustain professional networks and associated workplace relationships regardless of their locations. They also signal a need to develop policies practice and future research to assist a better organisational socialisation, in particular, the allocation of resources, better utilisation of time spent on education and workplace support in the transition into their clinical workplaces. What is already known about the topic? * Supporting new graduate nurses and midwives in their first year is important for their transition into the workforce and to increase their retention in the profession. * Onboarding processes for new graduates during their transition into the workplace enhances their professional knowledge and confidence, which increases their capacity to provide safe quality healthcare. * Few studies have investigated the relationship between the onboarding process and the promotion of organisational socialisation within the first three months of entering the health workforce. What this paper adds: * Findings identify the need to improve the onboarding process to better meet the complex needs of the new graduates. * Implementation of a tailored onboarding process, especially in rural and specialty areas improves organisational socialisation. [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]