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Objective: To determine impact of undertaking an international educational program during a nurse's or midwife's pre-registration program on subsequent practice, focusing on how nurses and midwives were transformed personally through participation in such programs. Background: Participation in international educational programs has been reported to enhance nursing and midwifery students' personal and professional development, however long-term impacts remain unclear. This paper presents findings drawn from a larger grounded theory study. Study design and Methods: Charmaz's grounded theory methodology was used to elicit experiences from 13 general nurses, two mental health nurses, three midwives and four dual qualified nurse/midwives across eight different countries. Data analysis led to the creation of three categories, with this paper reporting on the category of Developing as a Person. Findings: Participation in international educational programs can be transformative for nurses and midwives with long-lasting impacts, contributing positively to their personal growth and development. Discussion: The study findings underscore significant long-term impacts of international educational programs for nurses and midwives. These outcomes highlight the importance of incorporating international experiences into healthcare education. Conclusion: By providing opportunities for healthcare professionals to engage with diverse settings and populations, organisations and educational institutions can foster the development of well-rounded and globally competent practitioners. Implications for research, policy, and practice: The study's findings hold significant implications for research, policy, and practice in healthcare education. To deepen our understandings, additional longitudinal research across diverse countries is warranted. Policymakers have an opportunity to acknowledge the positive impact of these programs on the personal growth and development of nurses and midwives, potentially leading to the integration of global competency requirements into licensure programs. In order to provide comprehensive education, educational institutions should consider the inclusion of study abroad opportunities, cultural exchanges, and global clinical placements within nursing and midwifery curricula. What is already known about the topic? • International educational programs are widely used as a way of developing nursing and midwifery students' cultural understandings. • Previous studies have reported on short-term impacts of international educational programs. What this paper adds: • Long-term impacts of participation in an international educational program on nurses and midwives are described. • Personal development and subsequent transformations occur for nurses and midwives as a result of participation in international educational programs. [ABSTRACT FROM AUTHOR]

Objective: This review aimed to better understand barriers to and facilitators of the professional integration of internationally qualified nurses (IQNs) in Australia. Background: Nursing shortages are a critical global issue, including developed countries such as Australia, where about 20% of the nursing workforce has been trained overseas. IQNs face many challenges associated with the migration process itself; and their professional integration is crucial in retaining them in the workforce and in maintaining the quality of nursing care in Australia. Study design and methods: This review followed the JBI methodology for mixed methods systematic review. Web of Sciences, Scopus, Informit, ProQuest, Ovid, and Cinahl databases were searched from inception. Qualitative, quantitative, and mixed methods original studies, published in English, were considered. Screening, data extraction and quality assessment were conducted independently by two reviewers. The assessment of methodological quality used the JBI Qualitative Checklist and Checklist for Analytical Cross-Sectional studies, and the data were extracted using the JBI data extraction tool. Disagreements were resolved by a third researcher and the synthesis used a convergent integrated approach. Results: From an initial 110 studies, eight studies were included. Individual and social factors emerged as the main themes. The first theme was analysed in terms of two sub-themes: psychological adaptation plus communication and language. Social factors were analysed in terms of three sub-themes: a) cultural differences in the nursing role; b) support, mentoring and appreciation and c) discrimination and racism. Discussion: psychological adaptation and language proficiency are linked to personal factors. Cultural differences in the nursing role should be addressed with strong support and mentoring programs. Recognition of previous experience and appreciation of pre-existing skills are important facilitators. Discriminatory and racist behaviours continue in the work setting, yet are rarely reported. Conclusion: Discrimination and racism from colleagues, co-workers, and patients should be addressed with a more direct approach than is currently in place. Training of locally and internationally qualified nurses in intraprofessional cultural competence may improve interaction and communication, reduce racism and discriminatory practices, and increase quality of care. Implications for research, policy, and practice: This research may be of interest to policy makers, healthcare educators, healthcare workforce planners and healthcare institutions. This study contributes to our understanding of the phenomena of nurse migration, retention, and professional integration, especially in high income countries. It is also a call to address the persistence of discriminatory and racist practices in the Australian context, as well as the education in intraprofessional cultural competence of some local nurses who work with IQNs. What is already known about the topic? • High-income countries like Australia rely on the attraction and retention of IQNs to meet their health outcomes. • Personal characteristics, language proficiency, support and mentoring programs are strong facilitators for IQNs' professional integration. • The persistence of discriminatory and racist practices are barriers to integration of IQNs in Australia. What this paper adds: • In Australia discrimination and racism continue to be dominant barriers to IQNs' professional integration. • It is crucial to improve the reporting of situations involving discrimination and racism and discuss further consequences for patients, visitors, and co-workers. • It is essential to promote training programs in intraprofessional cultural competence, and to focus on working with IQNs, as well as caring for patients from culturally and linguistically diverse (CALD) backgrounds. [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: This study aims to determine the effect of deep breathing and coughing exercise training before surgery on respiratory functions and exercise tolerance in patients with open-heart surgery in the postoperative period. Background: The decrease in respiratory functions and activity tolerance of patients after open heart surgeries reveals the need to improve this situation with effective interventions. Methods: The quasi-experimental study was conducted with 80 patients undergoing open-heart surgery. Data were collected using the patient information form and the patient follow-up form. The patients were taught deep breathing and coughing exercises before the open-heart surgery and were supported in exercising regularly before and after the surgery. The patients' respiratory functions and exercise tolerance were measured and recorded via the patient follow-up form. Results: It was determined that the respiratory capacity, distance, time, and walking speed of the patients in the experimental group during the postoperative period were significantly higher than the control group. Conclusion: Substantially, deep breathing and coughing exercise training administered before surgery to patients undergoing open heart surgery improved respiratory functions and exercise tolerance in the postoperative period. It is recommended that nurses working in open-heart surgery clinics should plan deep breathing and coughing exercise training in the preoperative period and administer them regularly to the patients. Implications for research, policy, and practice: Patients who will undergo open heart surgery should be trained by nurses in the preoperative period. Nurses should teach these patients deep breathing and coughing exercises. In the postoperative period, it should be checked regularly whether the patients do exercises or not. What is already known about the topic? • It is important to teach and practice breathing exercises in patients who will have open heart surgery. • Respiratory training given by nurses in the preoperative period contributes to the management of the postoperative process. What this paper adds: • This article demonstrates the importance of preoperative education for patients undergoing open heart surgery. • In this study, it is shown that open heart surgery has a negative effect on the respiratory capacity and exercise tolerance of the patients. • In addition, in this study, it is shown that the respiratory capacity and exercise tolerance of the patients who were taught preoperative breathing exercises and who performed the exercises in the postoperative period increased in the postoperative period. [ABSTRACT FROM AUTHOR]

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

Objective: To describe and analyse barriers and facilitators to managing uncertainty in nurses' clinical reasoning in post-anaesthesia care units. Background: The diagnostic process in complex clinical settings often involves uncertainty. This can bias clinical reasoning and compromise the safety of healthcare. Still, little is known about how nurses deal with uncertainty in their clinical practice. Study design and methods: This study employs a qualitative descriptive design. Fourteen nurses working at a post-anaesthesia care unit were selected through convenience sampling. Data was collected through semi-structured interviews and analysed using thematic analysis. The deductive analysis was undertaken based on the Theory of Reasoned Action. This study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Results: Two major themes emerged from the analysis: 'barriers' and 'facilitators'. Each major theme aggregated four themes: intention to perform the behaviour, attitudes, subjective norms, and external variables. Discussion: The perceptions of barriers and facilitators provide valuable insights into current and desired practices that can help minimise uncertainty in nurses' clinical reasoning in post-anaesthesia care units. They provide knowledge and future direction for clinical practice improvements by addressing motivations for reasoning behaviour. The need to create more nurse-friendly working conditions and reduce the cognitive and emotional impact of uncertainty was also identified. Conclusion: This study provides a comprehensive list of barriers and facilitators of uncertainty management in clinical reasoning based on nurses' perceptions. Recognising behaviours based on reasoned action is essential to manage uncertainty in nurses' clinical reasoning. Implications for research, policy, and practice: These findings can be used by different stakeholders to better manage uncertainty in healthcare settings. They are valuable resources for health professionals, researchers, and healthcare institutions attempting to improve health practices and enhance safety in health services. What is already known about the topic? • The safety and quality of post-anaesthesia care is highly influenced by the clinical reasoning of healthcare providers. • In complex clinical settings, such as post- anaesthesia care units, uncertainty in clinical reasoning is common and expected. • Identifying barriers and facilitators of clinical reasoning is essential to support nurses cope with uncertainty in post-anaesthesia care units. What this paper adds: • Embracing uncertainty as an opportunity for personal and professional development is a facilitating factor. • The barriers to managing uncertainty are related to individual personality characteristics and the nature of interpersonal and professional relationships. • Maladaptation to uncertainty in clinical reasoning has a major impact on nurses' wellbeing in post-anaesthesia care units. [ABSTRACT FROM AUTHOR]

Objective: To explore the experiences of close family members when another family member is using methamphetamine and how the family member responds over time. Background: Methamphetamine use has widespread implications and harms for both people who use the drug and those that live with them. While there is a significant representation in the literature relating to family members of people who use drugs or alcohol, there are limited studies specifically considering family members experiences of methamphetamine use. Families have been shown to have both positive and negative impacts on people using drugs, but less is known on the impact on the family members themselves. Study design and methods: Multiple semi- structured qualitative interviews were conducted with 11 families (17 individual participants) from regional and metropolitan Western Australia over a 12-month period. Interpretative Phenomenological Analysis was used in data collection and analysis. Results: Four main themes were identified: 1. the New Lifeguard describes family members' unplanned insertion into a new role and their rapidly changing experience of the person using methamphetamine. 2. Hit by the Wave demonstrates participants' experience of repeated and unpredictable impacts on their lives. 3. Life in the Ocean describes the groundlessness associated with changes to goals and family structure. 4. Learning to Surf illuminates the changing strategies employed over time, moving away from trying to fix the person, to participants managing their own wellbeing. Discussion: This study identified common aspects within the lived experience of close family members of people using methamphetamine and ascertained a commonality in the process of this experience. Significant impacts to all areas of life were reported, and distress was fluctuating and unpredictable in line with the cyclical nature of the drug use. Participant responses to these changes varied over time between resentment and trying to fix things, and acceptance and resilience, while gaining or maintaining like-minded supports. Conclusion: Understanding the issues faced by families around this unique drug is vital in providing informed interventions for this group. Family members experience a broad range of financial, social and health impacts and harms over a protracted length of time. They are often not the focus of available support and in adapting to these issues, will themselves seek support away from treatment services for the person using methamphetamine. Implications for practice Understanding the complex journey of families has a broad range of implications (and opportunities) for a variety of areas such as criminal justice, family support and child protection. There is an opportunity for these areas to consider broader and more specific supports and approaches, and to develop more appropriate, bespoke, and inclusive treatment for families of people using methamphetamine. What is already known about the topic? • Methamphetamine is recognised worldwide as a harmful drug with few effective treatments for methamphetamine dependence. • Few studies exist exploring the specific impact of methamphetamine on family members. • Fewer studies explore the experiences over time. What this paper adds: • Family members with a relative who is using methamphetamine experience a range of harms in many areas of their lives. • The impact of methamphetamine use is unpredictable and takes place over long periods of time, affecting both individual family members and impacting on the overall structure of the family unit. • Families and family members adapt their approach over time, from attempting to fix the situation, to stepping back and seeking support from others who they perceive to be in similar circumstances. [ABSTRACT FROM AUTHOR]

Objectives: The study investigated how senior residential aged care staff perceived the purpose, function, impact and challenges of implementing a new role in their organisation for an unregistered care worker with a Bachelor of Dementia Care: the Dementia Care Support Worker. The role was piloted over two years in an Australian organisation with three aged care facilities to examine its potential to address gaps in service provision for people with dementia. Background: The residential aged care workforce is under pressure to care for residents with increasingly complex health conditions and where most care is provided by care workers. Presently no formal leadership role exists for care workers with specialised dementia knowledge in the aged care setting. Study design and methods: A qualitative descriptive approach was taken to explore senior staff members' perceptions of the role at two time points. Twenty-three semi-structured interviews held in July-August 2017 (n = 12), soon after role commencement, and in February-March 2019 (n = 11) were thematically analysed. Results: Three themes reflected senior staff members' expectations of the role: enhancing staff and management knowledge about dementia and dementia care practices; facilitating changes to improve care for residents living with dementia; and educating and supporting residents' families. Eighteen months later, participants felt the role was helping meet the need for improved care of residents with dementia, and staff understanding of dementia. They suggested communication and support structures to improve role effectiveness. Discussion: Staff were receptive to the establishment of the Dementia Care Support Worker role and felt it resulted in improvement in dementia care. Success was contingent on strong organisational support and resourcing. Conclusion: Improving dementia knowledge of care staff is an essential first step in driving care quality improvements. The Dementia Care Support Worker role for care workers has the potential to address knowledge needs and support improved care practices. Implications for research, policy, and practice: This research models how a new role might be configured for unregistered care workers with specialist dementia knowledge. Further research is needed to explore the establishment of such a role more widely in other organisations, to investigate whether it could provide a new career development pathway for care workers and improve the skills and capacity of the aged care workforce. Substantial policy changes would also be required to support role viability, such as around increased salary. Research which examines the impact of such roles on care outcomes would complement the findings. What is already known about the topic? • While dementia is common in residential aged care, knowledge of dementia is typically low among the care staff. • Consequently, care staff are not equipped to meet the complex needs of residents with dementia and their families. • New roles for unregistered care workers with specialised dementia knowledge have been proposed, but not tested. What this paper adds • This research models how a new role might be configured for care workers with specialist dementia knowledge. • Aged care facility leaders support a role for care workers with formal specialist dementia knowledge and skills, and perceive the role helps improve the quality of resident care and develop stakeholders' dementia knowledge. • Appropriate communication and support structures are required for the effective establishment of the role. [ABSTRACT FROM AUTHOR]

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

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

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

Objective: To discuss and provide insights on how to critique the psychometric properties of measurement instruments used by nurses and nurse researchers. Design and data sources: Methodological discussion paper that is based on our own experiences and research and is supported by literature. Primary argument: Nurses routinely use a variety of measurement instruments during their everyday practice. They do so with the assumption that the instrument has been thoroughly validated and has been shown to be reliable. There is the real possibility that frontline nurses are using measurement instruments that have not been validated in their patient population or context. Critiquing the psychometric properties of measurement instruments is, however, particularly complex. Complicating matters, there are conflicting standards regarding the quality criteria needed for validating the psychometric properties of measurement instruments. Conclusion: Nurses need to be aware of the limitations of the measurement instruments they use. Consequently, nurses need to have some understanding about the psychometric domains of measurement instruments and their associated measurement properties, as well as the quality criteria used for evaluating these measurement properties. Through discussing these aspects this paper aids frontline nurses and nurse researchers in critiquing the research literature regarding an instrument's psychometric properties. This paper equips nurses for making informed decisions when evaluating whether an instrument is suitable for use. What is already known about the topic? * There is the possibility that nurses are using measurement instruments that have not been validated in their patient population * A measurement instrument's psychometric properties should be re-established when used in a different patient population or context to the index study What this paper adds: * This paper provides nurses and nurse researchers with the necessary information for critiquing the research literature regarding an instrument's psychometric properties * This paper equips nurses to make informed decisions for effecting change in deciding whether an instrument is suitable for use [ABSTRACT FROM AUTHOR]

Background: Midwifery vacancies persist in small maternity units in Australian rural and private settings where midwives are expected to also care for general (non-maternity) patients when midwifery activity is low. Recruiting dual registered nurse/midwives over single registered midwives is preferred, as single registered midwives are seen as inflexible to assist with nursing work. Little is known about single registered midwives’ contribution to care of general patients in small maternity units. Objective: This scoping study aimed to consult single registered midwives and managers of single registered midwives to determine perspectives on single registered midwives’ contribution in small maternity units where the workload encompasses both midwifery and care of general patients, to inform further research. Study design and methods: This study used a qualitative description design. Two online focus groups were held, one containing three single registered midwives, the other three managers of single registered midwives. Similar questions were posed to each group about single registered midwives’ contribution to care in small maternity units. Data analysis was conducted collaboratively through coding and thematic categorisation processes. Results: Four major categories were found. Single registered midwives’ scope of practice concerning general patients is undefined; single registered midwives possess transferrable clinical skills applicable to general patients; practical, professional, and emotional barriers exist for single-registered midwives in small maternity units; and future research recommendations include scope of practice and workplace experiences. Discussion: Persistent midwifery vacancies are implicated in the closure of small maternity units to the detriment of childbearing families. Understanding the contribution of single registered midwives in small maternity units will inform future research and midwifery recruitment strategies to improve access to services. Conclusion: The experiences of single registered midwives working in small maternity units warrants further investigation. This scoping study contributes to the literature about single registered midwives’ experiences in small maternity units and suggests considerations for future research. Implications for research, policy and practice: Findings from this study provide information about the contribution of single registered midwives to small maternity units where there is an expectation to contribute to care of general patients in addition to midwifery. Future research into the experiences of single registered midwives working in these settings will generate information to inform recruitment strategies, potentially improving access to maternity care in small maternity units and may be used in the review of midwifery regulation and educational standards. What is already known about the topic? • Midwifery vacancies persist in small maternity units in rural and regional areas where the workload comprises both midwifery and nursing practice, despite strategies to recruit dual registered nurse/ midwives. • Dual registrants face challenges in maintaining both nursing and midwifery professional obligations in small maternity units. • There are increasing numbers of single registered midwives registering each year in Australia and educational opportunities to become a single registered midwife exist in rural settings. What this paper adds: • Single registered midwives make a useful contribution to care in small maternity units, and they assist with the care of general patients. • The scope of practice for single registered midwives in assisting with general patients is not defined. • Recommendations for future research include scope of practice for assisting with general patients and workplace challenges faced by single registered midwives because of their midwife-only qualification. [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: We report on a qualitative study of community nurse encounters with early relational trauma in parent-infant dyads. Background: Early relational trauma involves interactional or emotional disturbance in the parent-infant dyad. Earliest possible detection is needed to mitigate negative impacts on socio-emotional development, but early relational trauma is often challenging for practitioners to detect and respond to. Study design and methods: Maternal and Child Health nurses in Victoria, Australia received workforce training to address this. We interviewed 20 nurses both before and after they received specialist training, to understand their lived experiences in encountering client trauma and perceived changes to their professional confidence and competence post-training. The study comprised two areas of enquiry: i) a phenomenological analysis of nurses' lived experiences in encountering possible trauma; and ii) a grounded theoretical analysis of the context of trauma encounters at baseline, and perceived change in competence at follow-up. Results: Nurses who coped well when working with trauma maintained a level of emotional distance and were able to draw on a repertoire of well-established practice skills. The specialist workforce training resulted in clear gains in nurses' confidence and capacity to identify and respond to early relational trauma. Implications: Findings highlight a need for frontline services to provide specialist training and supervision in relational trauma and to cultivate cultures of communication and support. Such programs would optimally be deployed widely, to equip professionals with enhanced knowledge and confidence to create timely change in the face of early relational trauma. What is already known about this topic? * Effective recognition of early relational trauma is critical to enable relational repair. * Frontline health services are well placed to achieve timely identification of early relational trauma, but it can be challenging for practitioners to detect and respond to the signs of early trauma. * Working with relational trauma and feeling uncertain about trauma-related decision-making are distressing, but little is known about the lived experiences of professionals required to detect and respond to parent-infant trauma when lacking specialist knowledge. What this paper adds * We interviewed nurses i) before and ii) after they received specialist training in early relational trauma, to understand their lived experiences in encountering possible trauma and their perceived changes to professional confidence and competence post-training. * We found that nurses who coped well when working with trauma maintained a level of emotional distance and drew on a repertoire of well-established practice skills. * The specialist workforce training described here resulted in clear gains in nurses' confidence and skills for identifying and responding to early relational trauma, and we interpret findings with reference to recommendations for broader workforce training and supervision. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to determine views and experiences of intensive care unit nurses and patients on the issue of protecting patient privacy. Background: Intensive care should be delivered to protect the privacy of intensive care patients because these patients experience a loss of personal identity and significant limitations in physical activity and emotional expression. Intensive care patients may not be able to dress themselves; they may not communicate effectively without glasses and hearing aids; they cannot control the environment; they may not govern their actions, and they may not advocate for themselves. For these reasons, nurses should assume a primary role to protect patient privacy because they spend many hours with them and witness patients' loneliness, pain, and death as their primary caregivers. Study design and methods: This is a qualitative study using a phenomenological method with data gathered through interview. The study was conducted with nurses (n = 14) and patients (n = 14) in the intensive care units of a state hospital in a metropolitan city in Turkey between 12 March 2018 - 4 October 2019. Data were collected from nurses and patients using semi-structured interview forms. Content analysis revealed categories, themes, and sub-themes. We have followed the Consolidated criteria for reporting qualitative research (COREQ). Results: The categories explored in the study for both nurses and patients were the concepts of privacy, privacy protection and privacy violation. Some of the sub-themes were physical privacy, not sharing personal information, using screens or curtains, using aprons or sheets, insufficient number of nurses or excessive number of patients, and a lack of inspection and equipment. Conclusion: This study shows that the acquired information and the awareness of privacy, protection of privacy, and violations of privacy were adequate among both nurses and patients. Some of the nurses in the study stated that institution-related violations occurred because of the inadequate numbers of nurses to provide care to an exceedingly large number of patients. The implications for research, policy, and practice: Increasing awareness of nurses and patients on patients' rights and protection of privacy and violations of privacy and taking adequate measures to protect patient privacy increase both patient satisfaction and service quality in health. What is already known about the topic? * Privacy is a fundamental human right. * Protection of patient privacy is the responsibility of healthcare professionals. What this paper adds: * The awareness of patient rights for privacy and privacy protection has been well established among patients and nurses, and both participating patients and nurses were knowledgeable of respective privacy violations. * Institution-related factors such as the insufficient numbers of nurses, exceedingly large numbers of patients, problems with the main door access control systems in intensive care units, and the provision of care in smaller units than optimum ones are significant factors involved in the privacy violations of patients. * Patients were reluctant to report privacy violations because they believed this could negatively affect their treatment and care. [ABSTRACT FROM AUTHOR]

Objective: This study explored healthcare workers' experiences of transitioning infusions of natalizumab from hospital to a patient-centred model of home care. Background: Hospital in the home is one of the fastest growing healthcare delivery models. In Australia, intravenous infusions are rarely available at home for chronic disease patients, such as those with multiple sclerosis. A recent trial of natalizumab infusions at home for patients with multiple sclerosis required both the hospital and hospital in the home staff to consider the logistics of how this transition could be achieved safely. Study design and methods: This was a qualitative study using an exploratory-descriptive approach. Twelve participants from two main groups of healthcare workers participated in delivering natalizumab infusions during the six-month trial period and were subsequently interviewed about their experience. Participants were recruited from a hospital ambulatory care day unit and a Home Infusion Team from a private provider of home nursing care located in South Australia. The data was analysed thematically. Results: Three main themes were identified from the interviews: 'preparing for change', 'focussing on the patient', and 'enhancing professional support and relationships'. These findings demonstrated the importance of understanding healthcare workers' experiences of transitioning to a patient-centred model of care, from hospital to home infusion of natalizumab. Discussion: Flexibility and good management of logistics is necessary to maintain the standards of the health services, which highlights the need for training and professional support to facilitate quality home care. This may enhance workers' sense of professional confidence and trust and reduce stress when delivering the home model of care. Conclusion: Healthcare workers and patients worked to support one another, not only therapeutically but also logistically within collegial relationship and interdependent communications. Being flexible, communicating clearly and being willing to work together within the team, especially between the hospital in the home staff and the hospital staff, was demonstrated to be an important factor for the safe delivery of infusions at home. Managing the logistics of delivering a flexible and safe home therapy service was an important part of this model of care. Implications for research, policy, and practice: The results of this study will be used to inform healthcare teams about the key logistical components that are important for healthcare services, when considering transitioning to a home-based model of care for treating people with relapsing-remitting multiple sclerosis. What is already known about the topic? * Although outpatient infusion programs are often hospital based, they may be run by regional health authorities or private organisations, such as a hospital in the home service. * Healthcare workers delivering a hospital in the home service require advanced knowledge and skill in order to deliver quality care. What this paper adds: * The development of a comprehensive logistical process, which has the patient at the centre of the model of care, enabled natalizumab to be delivered safely in the community by healthcare workers. * Being flexible, communicating clearly and being willing to work together within the team, especially between the hospital in the home staff and the hospital staff, was demonstrated to be an important factor for the safe delivery of infusions at home [ABSTRACT FROM AUTHOR]

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

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

Objective: The aim of this study was to describe the views and expectations concerning home healthcare from the perspective of older South Sami women and men in comparison with each other. Study design and methods: In this study, 56 older South Sami women (n=31) and men (n=25) were interviewed by telephone, using semi-structured interviews. Data was subjected to qualitative content analysis. Results: Our results revealed both similarities and some slight differences between the male and female participants. Both male and female participants expected the same care providers over time, in addition to expecting competence. Additionally, our female participants stressed that care providers should use time in their encounters with them as care receivers. For some female participants, this was related to competence. The findings also revealed that the care providers' cultural backgrounds were of importance to both female and male participants, even if female participants preferred care providers with a South Sami background to a greater extent. The male participants stressed that having care providers with a South Sami background could be of importance, but they were more concerned about the care providers' competence in the encounters with them as future care receivers. The main findings show that older South Sami women and men mostly have similar expectations of future home healthcare. Conclusions: Our results highlight that having the same care providers over time, with the necessary competence, is of importance to our participants. Additionally, participants prefer their care providers to have a South Sami background -- although not at the expense of competence -- and this was especially highlighted by the South Sami men. Implications for research, policy, and practice: Our study indicates that, if possible, in encounters with South Sami women and men, home healthcare services should facilitate for the same care providers over time and that they should be competent, preferably of a South Sami background, and speak South Sami if the care receiver has mastered the Sami language. What is already known about the topic? * Older South Sami people want the same care providers over time, with individual adjustments and competent care providers in home healthcare. * There are contradictions in and between older South Sami people, about having care providers with South Sami background speaking South Sami in home healthcare. What this paper adds * Older South Sami women and men mostly have similar expectations of future home healthcare. * Home healthcare services should facilitate for the same care providers over time and that these should be competent and preferably of a South Sami background. [ABSTRACT FROM AUTHOR]

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

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