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Human trafficking is a pandemic human rights violation with an emerging paradigm shift that reframes an issue traditionally seen through a criminal justice lens to that of a public health crisis, particularly for children. Children and adolescents who are trafficked or are at risk for trafficking should receive evidence-based, trauma-informed, and culturally responsive care from trained health care providers (HCPs). The purpose of this article was to engage and equip pediatric HCPs to respond effectively to human trafficking in the clinical setting, improving health outcomes for affected and at-risk children. Pediatric HCPs are ideally positioned to intervene and advocate for children with health disparities and vulnerability to trafficking in a broad spectrum of care settings and to optimize equitable health outcomes.

The American Society for Parenteral and Enteral Nutrition (ASPEN) Position Paper focus is on applying the 4 ethical principles for clinician's decision-making in the use of artificially administered nutrition and hydration (AANH) for adult and pediatric patients. These basic principles are (1) autonomy, respect the patient's healthcare preferences; (2) beneficence, provide healthcare in the best interest of the patient; (3) nonmaleficence, do no harm; and (4) justice, provide all individuals a fair and appropriate distribution of healthcare resources. Preventing and resolving ethical dilemmas is addressed, with an emphasis on a collaborative, interdisciplinary approach. Optimizing early communication and promoting advance care planning, involving completion of an advance directive, including designation of a surrogate decision-maker, are encouraged. Clinicians achieve respect for autonomy when they incorporate the patient, family, community, country, geographical, and presumed cultural values and religious belief considerations into ethical decision-making for adults and children with a shared decision-making process. These discussions should be guided by the 4 ethical principles. Hospital committees and teams, limited-time trials, clinician obligation with conflicts, and forgoing of AANH are addressed. Specific patient conditions are addressed because of the concern for potential ethical issues: coma, decreased consciousness, and dementia; advanced dementia; cancer; eating disorders; and end-stage disease/terminal illness. Incorporated in the Position Paper are ethical decisions during a pandemic and a legal summary involving ethical issues. International authors presented the similarities and differences within their own country or region and compared them with the US perspective.

Background Missed nursing care is a complex healthcare problem. Extant literature in this area identifies several interventions that can be used in acute hospital settings to minimise the impact of missed nursing care. However, controversy still exists as to the effectiveness of these interventions on reducing the occurrence of missed nursing care. Aim This theoretical paper aimed to provide a conceptual understanding of missed nursing care using complexity theory. Methods The method utilised for this paper is based on a literature review on missed care and complexity theory in healthcare. Results We found that the key virtues of complexity theory relevant to the missed nursing care phenomenon were adaptation and self-organisation, non-linear interactions and history. It is suggested that the complex adaptive systems approach may be more useful for nurse managers to inform and prepare nurses to meet uncertain encounters in their everyday clinical practice and therefore reduce instances of missed care. Conclusions This paper envisions that it is time that methods used to explore missed care changed. Strategies proposed in this paper may have an important impact on the ability of nursing staff to provide quality and innovative healthcare in the modern healthcare system.

"Background: This position paper highlights the opportunistic integral role of the pharmacist across the patient pathway utilizing cardiovascular care as an example. The paper aims to highlight the potential roles that pharmacists worldwide can have (or already have) to provide efficient patient care in the context of interprofessional collaboration. Methods: It results from a literature review and experts seeking advice to identify existing interventions and potential innovative interventions. We developed a conceptual framework highlighting seven critical phases in the patient pathway and for each of those listed some of the initiatives identified by our experts worldwide. Results: Existing pharmacists' interventions in each of these phases have been identified globally. Various examples in the area of prevention and self‐management were found to exist for long; the contribution for early detection and subsequently to timely diagnosis were also quite clear; integration of care was perhaps one of the areas needing greater development, although interventions in secondary care were also quite common. Tertiary care and end of life interventions were found to often be left for other healthcare professionals. Conclusion: On the basis of the findings, we can argue that much has been done but globally consider that pharmacists are still an untapped resource potentially useful for improved patient care." info:eu-repo/semantics/publishedVersion

BackgroundThe EAPC White Paper addresses the issue of spiritual care education for all palliative care professionals. It is to guide health care professionals involved in teaching or training of palliative care and spiritual care; stakeholders, leaders and decision makers responsible for training and education; as well as national and local curricula development groups.MethodsEarly in 2018, preliminary draft paper was written by members of the European Association for Palliative Care (EAPC) spiritual care reference group inviting comment on the four core elements of spiritual care education as outlined by Gamondi et al. (2013) in their paper on palliative care core competencies. The preliminary draft paper was circulated to experts from the EAPC spiritual care reference group for feedback. At the second stage feedback was incorporated into a second draft paper and experts and representatives of national palliative care organizations were invited to provide feedback and suggest revisions. The final version incorporated the subsequent criticism and as a result, the Gamondi framework was explored and critically revised leading to updated suggestions for spiritual care education in palliative care.ResultsThe EAPC white paper points out the importance of spiritual care as an integral part of palliative care and suggests incorporating it accordingly into educational activities and training models in palliative care. The revised spiritual care education competencies for all palliative care providers are accompanied by the best practice models and research evidence, at the same time being sensitive towards different development stages of the palliative care services across the European region.ConclusionsBetter education can help the healthcare practitioner to avoid being distracted by their own fears, prejudices, and restraints and attend to the patient and his/her family. This EAPC white paper encourages and facilitates high quality, multi-disciplinary, academically and financially accessible spiritual care education to all palliative care staff.

Background Over the last number of years, the healthcare system has become more complex in managing increasing costs and outcomes within a defined budget. To be effective through reform, especially moving forward from the COVID-19 pandemic, healthcare leaders, specifically in nursing, have an increased need for business acumen beyond traditional leadership and management principles. Aim This paper examines the concept of business acumen in the profession of nursing, specifically for managers and higher nurse leaders, establishing whether these skills are optional or essential. Discussion Nurses learn and develop broad skills in leadership and management, but less specifically about business or the broader system. With a contemporary Australian health system aiming to be more effective, nurses may require a greater level of business acumen to adequately understand the mechanics of business decision making in the system when designing care models, as well as representing the business potential of nursing in balance with clinical outcomes through reform. Conclusion The modern nurse, in addition to clinical skills, may need a foundational understanding of business evolving throughout their career, to maximise innovative growth across the system, in meeting the healthcare needs of our community now and into the future. Without a foundation level of business acumen and an understanding of the system across the profession, nurses may not be empowered with their full potential of being a strong voice influencing health system reform.

Antimicrobial resistance (AMR) continues to threaten global health. Although global and national AMR action plans are in place, infection prevention and control is primarily discussed in the context of healthcare facilities with home and everyday life settings barely addressed.\ud \ud As seen with the recent global SARS-CoV-2 pandemic, everyday hygiene measures can play an important role in containing the threat from infectious microorganisms.\ud \ud This position paper has been developed following a meeting of global experts in London, 2019. It presents evidence that home and community settings are important for infection transmission and also the acquisition and spread of AMR. It also demonstrates that the targeted hygiene approach offers a framework for maximizing protection against colonization and infections, thereby reducing antibiotic prescribing and minimizing selection pressure for the development of antibiotic resistance. If combined with the provision of clean water and sanitation, targeted hygiene can reduce the circulation of resistant bacteria in homes and communities, regardless of a country's Human Development Index (overall social and economic development). Achieving a reduction of AMR strains in healthcare settings requires a mirrored reduction in the community.\ud \ud The authors call upon national and international policy makers, health agencies and healthcare professionals to further recognize the importance of targeted hygiene in the home and everyday life settings for preventing and controlling infection, in a unified quest to tackle AMR.

This position paper expresses current and future concerns about the use of robots in nursing. This statement reflects integration of humanoid nurse robots (HNRs) in nursing education, practice, and research. It is imperative nurses be directly involved in decisions about the design, implementation, and evaluation of the use of HNRs in healthcare. As questions arise about the ethical use of robots in nursing situations, caring theories will inform the implementation of HNRs in nursing to ensure the we protect the safety and the dignity of those entrusted to our care.

Open Dialogue is a need-adapted approach to mental health care that was originally developed in Finland. Like other need-adapted approaches, Open Dialogue aims to meet consumer’s needs and promote collaborative person-centred dialogue to support recovery. Need-adapted mental health care is distinguished by flexibility and responsiveness. Fidelity, defined from an implementation science perspective as the delivery of distinctive interventions in a high quality and effective fashion is a key consideration in health care. However, flexibility presents challenges for evaluating fidelity, which is much easier to evaluate when manualization and reproducible processes are possible. Hence, it remains unclear whether Open Dialogue and other need-adapted mental health interventions can be meaningfully evaluated for fidelity. The aim of this paper was to critically appraise and advance the evaluation of fidelity in need-adapted mental health care, using Open Dialogue as a case study. The paper opens a discussion about how fidelity should be evaluated in flexible, complex interventions, and identifies key questions that need to be asked by practitioners working in need-adapted mental health care to ensure they deliver these interventions as intended and in an evidence-based fashion.

Background and PurposeDespite different labels used to refer to different types of nursing theories by different authors, agreements were made on three major types of theories by level of abstraction. The purpose of this analysis was to discuss the characteristics of the three major types of nursing theories by level of abstraction that were published in refereed journals and to propose directions for future theoretical development in nursing.MethodsAn integrated literature review was conducted using PUBMED, CINAHL, and PsycINFO. A total of 116 articles were included in this analysis. The retrieved articles were sorted by the type of theories (by level of abstraction), and analyzed in terms of scope, theorizing process, specificity and abstraction, contextual understanding, links to research and practice, and diversity and generalizability. Finally, themes reflecting the characteristics of the three major types of nursing theories were extracted and discussed.ResultsA total of 17 themes were found. Although most of the themes reflected what were known about these theories, there were three new findings. First, all the grand theories that were reviewed tended to have more specific foci rather than explaining general nature, mission, or goals of nursing. Second, middle-range theories were developed based on various types/levels of theories using various sources for theorizing. Third, situation-specific theories began to be used to generate propositions and tested through statistical and qualitative analyses.Implications for PracticeThe efforts to try to link nursing theories to nursing practice need to be continued through further development and evaluation of the theories regardless of the types of theories.

Suicide is a major global public health issue, and in recent years, there has been increasing recognition of the problem of physician suicide. This American College of Physicians policy paper examines, from the perspective of ethics, the issues that arise when individuals and institutions respond to physician suicides and when they engage in broader efforts aimed at physician suicide prevention. Emphasizing the medical profession as a unique moral community characterized by ethical and professional commitments of service to patients, each other, and society, this paper offers guidance regarding physician suicide and the role of a healing community. The response to an individual physician suicide should be characterized by respect and concern for those who are grieving, the creation of a supportive environment for suicide loss survivors, and careful communication about the event. Because suicide is a complex problem, actions aimed at preventing suicide must occur at the individual, interpersonal, community, and societal levels. The medical community has an obligation to foster a culture that supports education, screening, and access to mental health treatment, beginning at the earliest stages of medical training.

The devastating global health impacts of climate change are becoming more apparent and more frequent. Health care systems are increasingly burdened by the response to these impacts. Paradoxically, as they respond to the negative health effects of climate change, these same resource intense health care systems are contributing to further climate change. Organizations and academics have issued a call to action for health care workers to mitigate climate change and promote environmental sustainability. Nurses are an integral part of health care systems but have been delayed in answering this call. In this paper we argue that nurses are particularly well suited to mitigating climate change in health care systems because their existing role is central to patient care, and as a result they interface with other health care providers and have developed proficiency in articulation work.

Aim The neonatal nurse practitioner role originated in the 1960's in the Unites States from a short fall in physicians. This occurred because of changes in medical training which reduced time in specialist areas and in conjunction, the demand for neonatal care increased due to the survival of premature babies and advances in specialised care. The aim of this review is to identify the discrepancies between roles and responsibilities, highlight the challenges NNP face and explore possible role development opportunities to make the position sustainable. Method Current review of the literature (MESH TERMS – neonatal and/or nurse practitioner, Australia) revealed fourteen published articles and government documents identifying requirements for endorsement and standards for nurse practitioner practice. Result Neonatal nurse practitioners spend most of their time delivering direct patient care regardless of the clinical setting, however elements of research, education and leadership are still incorporated within clinical practice. Alongside the clinical role, antenatal counselling, facilitation of communication amongst the multidisciplinary team and parents, prescribing, ordering diagnostic tests have all became core components to define the scope of the NNP. However, as the role has expanded NNP must adapt to changes to continue to be recognised as a valuable member of the multidisciplinary team especially as registered nurses start to take on extended roles. Conclusion The senior clinical role of the neonatal nurse practitioner continues to evolve. There are challenges to be overcome, however there are now more than thirty neonatal nurse practitioners in Australia and together the possibilities for expansion of their role are limitless. This can only be of benefit to our babies, their families and the nursing profession.

In ICU, one of the nurse's roles is to ensure proper nutrition support to facilitate their recovery. However, few nutrition protocols for nurses are found. The European federation of Critical Care Nursing associations (EfCCNa) position statement provides ICU nurses with evidenced guidelines regarding caring for critically ill patients with enteral nutrition support., info:eu-repo/semantics/published

Numerous socio-legal factors make the process of surrogate decision-making for people living in dementia very complicated in Japan. In this discussion paper, we argue that the lack of early consultation between patients, surrogate decision-makers and healthcare providers and the overreliance of patients and their families on doctors to assume the decision-making role lead to healthcare practices that may not align with the patient's wishes. Further, we argue that lack of laws on surrogate decision-making, changing family structure and the liabilities associated with the care of people living with dementia contribute to the complexity of the decision-making process in Japan. Finally, given the rapidly changing social and healthcare norms in Japan, we call for greater involvement of nurses and care workers in the decision-making process to ensure patient-centric treatment and care are adopted.

Summary The growing number of doctoral graduates in nursing management, together with more focus on qualitative studies, has contributed to the development of qualitative studies. This study aimed to provide a critical appraisal of qualitative research papers in the field of nursing management by Iranian authors, published in national and international journals. In a cross-sectional study, international and Persian electronic databases were used for a systematic search of the relevant literature using the keywords: qualitative studies, nursing management, and Iran. Criteria provided by the Critical Appraisal Skills Program (CASP) for the qualitative studies checklist was used for quality appraisal of the included studies. Of the 22 qualitative studies appraised, 48% had used grounded theory and 22% had adopted the research method of content analysis. The mean score for ethical consideration was 1.66 out of 4. The mean scores for rigor and research credibility were 5.123 out of 9 and 1.66 out of 4, respectively. In terms of research purpose and methodology, mean scores were 3.33 out of 4 and 2.22 out of 3, respectively. Quality of research design obtained the mean score of 2.66 out of 6 and the score for method of data collection was 4.44 out of 7. Results showed that quality of the published qualitative studies in the field of nursing management by Iranian authors seemed not appropriate and the most significant weakness was related to the partial compliance with ethical principles.

Short answer tests (SAT) are an assessment that examines nursing students' knowledge and can be used to evaluate expectations for student educational success. The purpose of this literature review is to combine the best available evidence as to whether short answer test papers meet nursing facility curricula learning outcomes. A literature review was performed consisting of data bases which included; ERIC, SCOPUS, CINAHL MEDLINE, COCHRANE LIBRARY and JOHANNA BIGGS INSTITUTE (JBI). The following keywords were used: Short answer test, written assessment, quiz, organisations, university, higher degree education, tertiary education, nursing, perceptions, attitude, opinions, thoughts, feeling and belief. The majority of studies demonstrated that short answer tests equip nursing students with the knowledge and critical thinking skills for the clinical setting. Three major themes were identified: the effects of increasing class sizes; authenticity and the validity of short answer tests. Short answer tests are commonly used in undergraduate nursing programs to evaluate students’ level of knowledge which consists of their ability to critically analyse and problem solve. To maintain authenticity and validity of an assessment, there is a need for an evidence-based approach to their design to meet the core learning objectives within the curriculum.

Around the world, school staff are increasingly expressing concern about nonsuicidal self-injury (NSSI) and how best to address this behavior in the school setting. However, there is a notable lack of informed guidance for schools, and clear inconsistencies in the practices school staff adopt. In this position paper we draw on our collective research and clinical expertise to provide best-practice guidelines for addressing NSSI in school settings. We outline the importance of a school protocol, and the key features all school protocols should contain. We also focus on how schools can minimize contagion of NSSI within their school environment. We believe these guidelines will be an important starting point for schools interested in developing an evidence-based approach to addressing NSSI.

Background: Indonesia is home to approximately 400 active volcanoes located on three different tectonic plates, which put it at risk of natural disasters. Accordingly, healthcare in emergencies and disasters is of great importance in Indonesia. Therefore, this study aimed at describing nursing students’ experiences of nursing education in disaster nursing in a university in Indonesia. Materials and Methods: This qualitative content analysis with an inductive approach was conducted by semi-structured interviews with eight nursing students from a university in Indonesia. Results: One category, namely, “Being prepared for a natural disaster”, and three subcategories, namely, “Feeling prepared in nursing”, “Managing limitations in nursing education” and “Managing uncertainty in nursing”, were identified. Nursing students considered that theory in disaster nursing was valuable; however, they lacked reality-based education to feel be prepared to perform the required tasks as forthcoming nurses. Conclusion: Increased and repeated practical training using case studies in nursing education is important for improving nursing students’ preparedness in disaster nursing.

Background The prevalence and impact of healthcare-associated infections (HAIs) is significant. While hand hygiene is well documented as the single most effective method to prevent HAIs, research and prevention has focused on the healthcare provider's hand hygiene. Studies validate the importance of the healthcare consumer's hand hygiene, finding consumers’ hands become a reservoir and means of transmission if not adequately cleansed. Although consumer hand hygiene is an obvious safety concern across healthcare settings, it is frequently overlooked and not routinely measured. Barriers to consumer hand hygiene include inaccessible supplies, irritating agents, lack of knowledge, forgetfulness, or lack of administrative leadership/support. Our evidence-based protocol for healthcare consumer hand hygiene addresses the roles and responsibilities of all within the healthcare community. Methods We appraised the scientific literature using Dang and Dearholt's (2018) five levels of evidence with Level 1 being the most stringent. We included fifty-four studies spanning 17 years (2002-2019); thirty-one studies published during the last 5 years in professional peer reviewed journals and twenty-three seminal studies more than 5 years old. There were 3 Level I studies, 26 Level 2 studies, 9 Level 3 studies, 15 Level 4 studies, and 1 Level 5 study. Studies differed in focus, design, methods, and included several countries, healthcare systems, and settings (hospitals, long-term care facilities, and the community), with hospitals being the most frequent setting. Results The evidence demonstrates a multi-modal approach to healthcare consumer hand hygiene is most effective. Key elements include leadership to implement and maintain high levels of adherence, education, consumer preference, and verbal and nonverbal reminders. Following implementation of a healthcare consumer hand hygiene protocol, increased rates of healthcare provider hand hygiene adherence and decreased rates of HAI were noted in the literature. Conclusions A healthcare consumer hand hygiene protocol may decrease HAIs, improve outcomes, and promote healthcare consumer engagement and satisfaction.

Aim To synthesize suicide prevention strategies for older adults. The review question was Which suicide prevention strategies are useful for older adults? Design Integrative review. Data sources Academic Search Premier, CINAHL, Ovid PsycINFO and PubMed were searched for articles published between January 2009 and December 2019. Review methods An integrative review of quantitative, qualitative and theoretical papers with a qualitative thematic analysis. Results Key aspects of the included studies contributed to the formulation of four themes: (1) Recognizing older adults’ physical and/or mental health problems and referring them for help and treatment, (2) Designing an educational programme, (3) Communication and dialogue about warning signs and (4) Social support and awareness of causing significant others emotional pain. The findings indicate an urgent need to identify effective suicide prevention strategies for older adults.

Background: People with intellectual disabilities often present with unique challenges that make it more difficult to meet their palliative care needs. Aim: To define consensus norms for palliative care of people with intellectual disabilities in Europe. Design: Delphi study in four rounds: (1) a taskforce of 12 experts from seven European countries drafted the norms, based on available empirical knowledge and regional/national guidelines; (2) using an online survey, 34 experts from 18 European countries evaluated the draft norms, provided feedback and distributed the survey within their professional networks. Criteria for consensus were clearly defined; (3) modifications and recommendations were made by the taskforce; and (4) the European Association for Palliative Care reviewed and approved the final version. Setting and participants: Taskforce members: identified through international networking strategies. Expert panel: a purposive sample identified through taskforce members’ networks. Results: A total of 80 experts from 15 European countries evaluated 52 items within the following 13 norms: equity of access, communication, recognising the need for palliative care, assessment of total needs, symptom management, end-of-life decision making, involving those who matter, collaboration, support for family/carers, preparing for death, bereavement support, education/training and developing/managing services. None of the items scored less than 86% agreement, making a further round unnecessary. In light of respondents’ comments, several items were modified and one item was deleted. Conclusion: This White Paper presents the first guidance for clinical practice, policy and research related to palliative care for people with intellectual disabilities based on evidence and European consensus, setting a benchmark for changes in policy and practice.

Holistic healthcare to the older person is important. Spirituality is considered to be the very essence of being and for some is what motivates and guides us to live a meaningful existence. Nurses caring for the older person need support in responding to their spiritual needs in order to ensure that they are appropriately and successfully met. The aim of this paper is to explore these needs and highlight some evidence indicating how this care can be implemented and therefore ultimately influence nursing practice. yes

OBJECTIVES In this paper, we provide an overview of best practices in FASD prevention, diagnostic, and interventions and supports. In Canada, people diagnosed with Fetal Alcohol Spectrum Disorder (FASD) represent a fraction people living with FASD. While social stigma may deter people from seeking an FASD diagnosis, other deterrents include the lack of screening and diagnostic referrals, cost of travelling to a clinic, and lack of clarity of how a diagnosis may improve supports and services. Preventing FASD and improving lifelong outcomes for people living with FASD requires a coordinated approach between prevention, diagnostic, intervention, and support efforts. METHODS Using the example of Newfoundland and Labrador, a province where 60% of the population lives in rural communities and benefits from being involved in national initiatives and partnerships, we discuss efforts underway in other Canadian provinces to address FASD. RESULTS We make three recommendations that begin to address FASD-specific needs in both rural and urban regions: a) a provincial FASD consultant position, b) an explicit partnership between provincial government and fasdNL, and c) increased access to FASD diagnostic teams. CONCLUSION While the recommendations are both modest and essential first steps, we also suggest that collaborations and resource-sharing in FASD prevention and supports are more about doing things differently, rather than doing more.

Aim To identify and analyse the 100 most cited papers on stress in nurses published in nursing journals. Background The number of citations an article receives is an index of its impact on the scientific community. An analysis of the most cited articles on stress in nursing would allow us to identify the most important articles and to obtain information about this area of knowledge. Design A retrospective bibliometric analysis. Data sources In 2016, 111 journals belonging to the "nursing" category were identified in the Science and Social Science Citation Index. A search was performed of the Science Core Collection Website for articles on stress published in these journals. Review methods The topic, type of article, publishing journal, countries and institutions of origin and year of publication were extracted from the articles. The impact factor, immediacy index, journal country and publisher and h index were collected from the Institute for Scientific Information. The citation density, citation tendency and Bradford's law were calculated. Results They identified articles were mostly empirical quantitative studies with a transversal design, published from 1975 - 2011 in 23 journals. They were signed by 233 authors, most of whom are English-speaking from the USA and UK. The core distribution of the publications comprises a single journal, the Journal of Advanced Nursing. Conclusion The study of stress in nursing has shown increased visibility and recognition each decade. The most recent articles have the highest number of citations, are the highest in rank and have the higher citation densities.

Aim To explore connections between spiritual metaparadigm and the nursing metaparadigm and advocate for a progressive spiritualization of nursing management. Background Relationship between the spiritual holistic metaparadigm of love, communion and gift and the holonic nursing metaparadigm of care, relationship and practice is not completely understood. Method The construction of a theoretical explanation on the basis of accumulated knowledge in the fields of nursing and spirituality (especially Christian spirituality) for the purpose of constructing a meaningful description. Results Deep connectivity between the elements of both metaparadigms: love and care, communion and relationship, and gift and practice. Conclusion The connection between the spiritual and nursing metaparadigms is real in nursing education, practice and management because of the holistic character of spirituality. In collective intentions and cultural values are the main channels of interaction between the nursing and the spiritual metaparadigms. Implications for nursing management Spirituality influences nursing management by, among other things, (a) providing meaning and purpose; (b) promoting cohesion in health communities; (c) fostering respect for ethics; (d) stimulating innovation; (e) encouraging leadership; and (f) illuminating the workplace.

Background The need for new graduate nurses to have the capabilities to function effectively in increasingly complex, dynamic and diverse health care settings has energised debate about the need for four year nursing degrees. Questions What types of four year bachelor degrees are evident globally and what are the key arguments and evidence suggesting a need for four year nursing degrees in Australia? Methods A scoping of contemporary literature is conducted to identify and discuss the key trends, concerns and evidence that informs the current debate on the appropriate duration of nursing degrees. Findings A unique combination of emerging health care challenges and shifting health care priorities are fuelling the call to reconsider the duration of nursing degrees in Australia. Discussion Future nurses will need the capabilities to work effectively across organisational and geographical boundaries, work as partners with a well-informed public, engage with advancing technologies and work autonomously and collaboratively as equals in inter-professional teams. Conclusion The need for nurse education to produce nurse graduates with key capability for the future, gives credence to a call for a four year nursing degree in Australia.

In their 2016 article, "Navigating a Managed Care Peer Review: Guidance for Clinicians Using Applied Behavior Analysis [ABA] in the Treatment of Children on the Autism Spectrum," Papatola and Lustig provide an overview of the managed care process, discuss the medical necessity of ABA, and offer guidance to clinicians on how to navigate the managed care peer review process. Given that the authors are employed by a large international health insurance carrier and conduct peer reviews on behalf of that organization, this response seeks to provide guidance from both the clinical and public policy perspectives that reflect best practices in the field of autism treatment. This response is not written with the intention of providing or replacing legal advice; rather, this paper offers health care providers of ABA an essential understanding of some of the laws that govern and support their efforts to secure medically necessary treatment and the mechanisms in place with which to challenge decisions by managed care organizations, health plans, and health insurance issuers that may be contrary to best practices. Finally, suggestions are offered on how to navigate a peer review to ensure optimal outcomes and, when necessary, to lay the groundwork to overturn a funding source decision that does not reflect best practices or the standard of care in ABA-based autism treatment.

The nursing care plan plays an essential role in supporting care provision in Australian aged care. The implementation of electronic systems in aged care homes was anticipated to improve documentation quality. Standardized nursing terminologies, developed to improve communication and advance the nursing profession, are not required in aged care practice. The language used by nurses in the nursing care plan and the effect of the electronic system on documentation quality in residential aged care need to be investigated.To describe documentation practice for the nursing care plan in Australian residential aged care homes and to compare the quantity and quality of documentation in paper-based and electronic nursing care plans.A nursing documentation audit was conducted in seven residential aged care homes in Australia. One hundred and eleven paper-based and 194 electronic nursing care plans, conveniently selected, were reviewed. The quantity of documentation in a care plan was determined by the number of phrases describing a resident problem and the number of goals and interventions. The quality of documentation was measured using 16 relevant questions in an instrument developed for the study.There was a tendency to omit 'nursing problem' or 'nursing diagnosis' in the nursing process by changing these terms (used in the paper-based care plan) to 'observation' in the electronic version. The electronic nursing care plan documented more signs and symptoms of resident problems and evaluation of care than the paper-based format (48.30 vs. 47.34 out of 60, P0.01), but had a lower total mean quality score. The electronic care plan contained fewer problem or diagnosis statements, contributing factors and resident outcomes than the paper-based system (P0.01). Both types of nursing care plan were weak in documenting measurable and concrete resident outcomes.The overall quality of documentation content for the nursing process was no better in the electronic system than in the paper-based system. Omission of the nursing problem or diagnosis from the nursing process may reflect a range of factors behind the practice that need to be understood. Further work is also needed on qualitative aspects of the nurse care plan, nurses' attitudes towards standardized terminologies and the effect of different documentation practice on care quality and resident outcomes.

Pediatric Early Warning Scores are advocated to assist health professionals to identify early signs of serious illness or deterioration in hospitalized children. Scores are derived from the weighting applied to recorded vital signs and clinical observations reflecting deviation from a predetermined "norm." Higher aggregate scores trigger an escalation in care aimed at preventing critical deterioration. Process errors made while recording these data, including plotting or calculation errors, have the potential to impede the reliability of the score. To test this hypothesis, we conducted a controlled study of documentation using five clinical vignettes. We measured the accuracy of vital sign recording, score calculation, and time taken to complete documentation using a handheld electronic physiological surveillance system, VitalPAC Pediatric, compared with traditional paper-based charts. We explored the user acceptability of both methods using a Web-based survey. Twenty-three staff participated in the controlled study. The electronic physiological surveillance system improved the accuracy of vital sign recording, 98.5% versus 85.6%, P < .02, Pediatric Early Warning Score calculation, 94.6% versus 55.7%, P < .02, and saved time, 68 versus 98 seconds, compared with paper-based documentation, P < .002. Twenty-nine staff completed the Web-based survey. They perceived that the electronic physiological surveillance system offered safety benefits by reducing human error while providing instant visibility of recorded data to the entire clinical team.

Aims A discussion of an optimal set of indicators that can be used on a priority basis to assess the performance of nursing care. Background Recent advances in conceptualization of nursing care performance, exemplified by the Nursing Care Performance Framework, have revealed a broad universe of potentially nursing-sensitive indicators. Organizations now face the challenge of selecting, from this universe, a realistic subset of indicators that can form a balanced and common scorecard. Design Discussion paper drawing on a systematic assessment of selected performance indicators. Data sources Previous works, based on systematic reviews of the literature published between 1990 - 2014, have contributed to the development of the Nursing Care Performance Framework. These works confirmed a robust set of indicators that capture the universe of content currently supported by the scientific literature and cover all major areas of nursing care performance. Building on these previous works, this study consisted in gathering the specific evidence supporting 25 selected indicators, focusing on systematic syntheses, meta-analyses and integrative reviews. Implications for nursing This study has identified a set of 12 indicators that have sufficient breadth and depth to capture the whole spectrum of nursing care and that could be implemented on a priority basis. Conclusions This study sets the stage for new initiatives aiming at filling current gaps in operationalization of nursing care performance. The next milestone is to set up the infrastructure required to collect data on these indicators and make effective use of them.

Summary Simulation is recognised as a safe and effective way to teach nursing. Mask-Ed™ is a new and innovative simulation technique. It involves the use of a masked educator who portrays an authentic character with a history that serves as a platform for learning and teaching. This technique has been introduced in several nursing curricula throughout Australia, the United Kingdom, the United States of America and New Zealand. While student feedback remains positive, little is known about the effectiveness of the technique, which includes using silicone props, including masks in preparing students for clinical practice. Mask-Ed™ simulation has been shown to increase the students' feelings of readiness for clinical practice, and reduced some of their fear and apprehension. This paper explores the use of Mask-Ed™ as a valuable tool in teaching both the art and science of nursing.

Mental illness accounts for about one-third of adult disability globally, reflecting marked societal and personal suffering, and enormous social and economic costs. On a global level, mental healthcare has failed to adequately address urgent unmet needs of the mentally ill. These circumstances call for change in the paradigm and practices of mental healthcare, including fundamental reforms in education, clinician-training, and research priorities. This White Paper outlines current challenges in mental healthcare, and characterizes the emerging field of Integrative Mental Health (IMH), a critical element in the large-scale changes needed to transform mental healthcare in the 21st century. Strategic recommendations for advancing IMH are outlined including increasing research in key areas, improving clinician training and education, and promoting a public health agenda. The field of IMH adopts the bio-psycho-socio-spiritual model, utilizing evidence-based and evidence-guided treatments from both traditional healing systems and modern scientific practices. IMH incorporates mainstream interventions including the judicious use of psychopharmacology and psychosocial therapies, in addition to evidence-based complementary and alternative (CAM) medicines and therapies, and health-promoting lifestyle changes (i.e. enhancement of dietary, exercise, sleep, work/relaxation patterns). The clinical application of IMH takes into account the range of socio-cultural, economic and spiritual considerations affecting mental healthcare practice in different countries. To meet the challenges facing mental healthcare, the International Network of Integrative Mental Health (INIMH: www.INIMH.org) was established in 2010 (officially launched in October 2012) with the objective of creating an international organization consisting of clinicians, researchers, educators, and public health advocates. INIMH was created to advance a global agenda for research, education and the clinical practice of evidence-based integrative mental healthcare. In authoring this White Paper, the board of INIMH is inviting global dialogue on critical issues surrounding mental health care in the hope of achieving integrated, compassionate, individualized, person-centered mental healthcare.

지난 10년 동안 암 관리법에 의한 국가 정책에 따라 일본에서는 호스피스 및 완화의료가 급속히 발전해왔다. 완화의료 시설 및 입원 환자의 호스피스, 병원의 완화 의료팀, 가정 호스피스 기능을 갖춘 진료소의 수는 꾸준히 증가하고 있으며 국가 협회로부터 완화의료 전문가로 공인된 의사, 간호사, 약사의 수도 증가하고 ...

Article-at-a-Glance Background There is limited conformity among patient safety and quality improvement (QI) competencies of the knowledge, skills, and attitudes (KSA), by stage of skill acquisition, essential for all health professionals. A study was conducted to identify, categorize, critically appraise, and discuss implications of competency recommendations published in influential position papers. Methods A literature search was conducted of competency recommendations in position papers published by national and international professional associations, expert panels, consortia, centers and institutes, and convened committees, in the domain of patient safety and QI. To be included in the analysis, the competency had to be recommended in at least 20% (rounded) of the position papers. Qualitative content analysis was used to identify themes among the published competencies for the skill acquisition levels of competent and expert, using Dreyfus's definitions. Results On the basis of the 22 papers that met the inclusion criteria, 17 themes were identified among the 59 competencies for the skill level competent. Among the 23 competencies for the skill level expert, 13 themes were identified. Competencies within the theme "Evidence-Based Practice" were most frequently recommended across both skill levels. The themes "Interdisciplinary Teamwork and Collaboration" and "Evidence-Based Practice" were the themes identified among the greatest number of position papers for the skill level competent and expert, respectively. Conclusions The identified themes for competencies in patient safety and QI have implications for curriculum development and assessment of competence in education and practice. The findings in this study demonstrate a need to discourage publication of recommendations of yet more competencies and to instead encourage development of an international consensus on the essential KSA for patient safety and QI across all health professions and all levels of skill acquisition.

The purpose of the white paper is to provide relevant background information on the importance of certification for nursing and the subspecialty of radiologic nursing. The Association for Radiologic and Imaging Nursing (ARIN), Radiologic Nursing Certification Board (RNCB), and Radiologic Nursing Certification Task Force support the 2005 American Board of Nursing Specialties (ABNS) recommendations for nursing speciality certification.

Aim The Dutch Sentinel General Practice Network (SGPN) was founded in 1970 for disease surveillance in primary care, based on paper questionnaires. Advances in information technology offered new prospects of data collection from electronic health records (EHRs). This study investigates the resulting challenges for the SGPN and its transition towards electronic data collection.

This background paper aims to better understand and classify the needs of migrant, refugee and asylum seeker patients worldwide, and provides background information on the subject.

Effective team decision making has the potential to improve the quality of health care outcomes. Medical Emergency Teams (METs), a specific type of team led by either critical care nurses or physicians, must respond to and improve the outcomes of deteriorating patients. METs routinely make decisions under conditions of uncertainty and suboptimal care outcomes still occur. In response, the development and use of Shared Mental Models (SMMs), which have been shown to promote higher team performance under stress, may enhance patient outcomes. This discussion paper specifically focuses on the development and use of SMMs in the context of METs. Within this process, the psychological mechanisms promoting enhanced team performance are examined and the utility of this model is discussed through the narrative of six habits applied to MET interactions. A two stage, reciprocal model of both nonanalytic decision making within the acute care environment and analytic decision making during reflective action learning was developed. These habits are explored within the context of a MET, illustrating how applying SMMs and action learning processes may enhance team-based problem solving under stress. Based on this model, we make recommendations to enhance MET decision making under stress. It is suggested that the corresponding habits embedded within this model could be imparted to MET members and tested by health care researchers to assess the efficacy of this integrated decision making approach in respect to enhanced team performance and patient outcomes.

The purpose of this study is to explore undocumented immigrant women&rsquo, s experiences of, as well as their access to, maternity care services during pregnancy in Denmark. Recruiting through the two branches of a non-governmental organization (NGO)-driven health clinic in Denmark, we conducted 21 semi-structured interviews with undocumented immigrant women in Denmark from January 2018 to January 2019. The undocumented immigrant women experienced barriers such as fear of deportation, concerns about payment for services, and uncertainties about rules for access. Many of them described depending on NGO-driven initiatives to access maternity care services and found these as providing a safe environment for care. Our findings contribute insights towards understanding the health behavior of undocumented immigrant women and highlight the need for inclusive care to safeguard the health of the women and their children.

BACKGROUND The Healthy, Hunger-Free Kids Act of 2010 (HHKA) required schools to make changes to meals provided to children. Rural school districts have limited resources, with increased obesity rates and local food insecurity. In this study we sought to understand the perceptions of rural food service directors and the barriers to implementing the changes. METHODS Food service directors from rural school districts were invited to complete a semistructured telephone interview and online survey. A total of 51 respondents completed both, 6 completed only the online survey, and 16 completed only the telephone interview. Qualitative interview data were analyzed through open thematic coding; descriptive statistics were calculated for the quantitative data. RESULTS Food service directors mostly perceived the changes as negative, challenging, and burdensome. They believed that the changes resulted from concern about childhood obesity, which they did not view as a problem for their students. Diverse challenges were reported related to cost, preparation, and student preference. CONCLUSIONS Food service directors in isolated, rural areas need support to enhance understanding of HHKA requirements, build professional networks to learn from one another, and communicate with students, families, and other stakeholders. Future efforts should focus on changing perceptions and supporting directors in order to make implementation a success.