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Background: This paper describes quality improvement strategies implemented following the identification of a significantly high prevalence rate and severity of pressure injuries in a regional health care facility in a large health district in Queensland, Australia. Aim: The aim of this paper is to inform health professionals of processes employed to reduce the incidence and financial burden of pressure injuries following the detection of rates that were significantly above the State average. Method: An audit of pressure injury prevalence data was conducted on a single day throughout a regional hospital. Prevalence data was compared to State averages and hospital strategies used to prevent injuries were examined. Findings: Audit reports for this acute setting revealed that despite best practice guidelines, prevalence was a major concern. Lack of accountability, poor documentation, limited education and knowledge of risk assessment and prevention were central to the need to implement quality improvement processes. Conclusion: This paper outlines the results associated with implementing quality measures to reduce the prevalence of pressure injuries. Following an audit of pressure injury prevalence data, strategies were implemented to reduce noteworthy rates. Employing specific techniques can result in significantly decreasing hospital acquired pressure injuries in health care settings throughout the world. [ABSTRACT FROM AUTHOR]

School-Based Youth Health Nurses (SBYHNs) work in Queensland high schools, providing sexual and reproductive health care/advice (amongst other things) to adolescents. SBYHNs are often responsible for referring high school students to other health care practitioners or external health services/community agencies. One of the difficulties faced in this context is how to assess the issue of capacity in terms of the adolescent's ability to provide consent to his or her own health care without parental involvement. This is important because it enables SBYHNs to maintain confidentiality with adolescents, which encourages adolescents to obtain sexual health advice. In this paper we outline the key legal principles relevant to nurses working in this field. We provide some practical examples of issues faced by SBYHNs and consider how the issue of Gillick competency is relevant to these examples. We demonstrate that the law seeks to prioritise the concept of confidentiality and aims to avoid exposing adolescents to harm that may result from unsafe sexual practices. Importantly, the issues discussed in this paper are relevant to nurses working within this field in all Australian jurisdictions. [ABSTRACT FROM AUTHOR]

In Queensland, Aboriginal nurses are limited in number in comparison to the mainstream nursing workforce. More Aboriginal registered nurses are needed to cater for Aboriginal patients in our Australian healthcare system in view of today's burgeoning Indigenous health crisis. It is a foregone conclusion that Aboriginal nurses are the most suitable nurses to provide optimal cross cultural care for Aboriginal patients, due to having similar cultural backgrounds. The following paper will show how two Aboriginal registered nurses are optimistic about the possibilities of expanding the ranks of Aboriginal registered nurses through role modelling, and are channelling their research to achieve this with the aim of promoting better health outcomes for their people. A qualitative research approach has been used to examine the subjective human experience of the participants. Three dominant themes emerged from the research and will be expanded upon within the body of this paper to support the authors' thesis that Aboriginal nurses are a valuable commodity to address the Aboriginal health crisis. [ABSTRACT FROM AUTHOR]

Background: Public policy across the world is increasingly focusing on the role of mental health promotion in whole of health strategies. There is a growing evidence-base that mental health promotion, delivered by trained facilitators, is effective in promoting self-awareness and self-care to prevent the damaging effects of ongoing stress in one's life and to promote early detection of any possible emerging mental health problems. Within Australia, however, few clinicians or school staff are confident or trained in mental health promotion. Aims: This paper reports the results of a two-day training designed for facilitators of a mental health program for secondary-school students. The goal was to develop facilitators' knowledge and understanding of best practice in youth mental health promotion and to increase their confidence in delivering the program. Design: A mixed methods evaluation assessed the impact that a solution-focused training program had on participating facilitators. Methods: A questionnaire was created and included eight quantitative items and one open ended, qualitative question. Twenty-seven nurses and guidance officers from central Queensland were recruited via convenience sampling and data were analysed using descriptive statistics and thematic analysis. Results: The evaluation revealed that participants' perception of their ability to facilitate a youth mental health program significantly improved after completing the training. Qualitative data indicated that participants found the professional development experience to be valuable, provide useful and transferable skills, and believed it to be necessary for mental health promotion work. Conclusion: By providing detailed description of the program's content and processes, other mental health professionals may be inspired to further develop effective learning experiences. [ABSTRACT FROM AUTHOR]

This paper presents the findings of a study that interviewed Aboriginal nurses to explore their experiences of the whiteness of nursing. Despite concerted efforts to improve the health of Aboriginal Australians, it still remains equivalent to third world countries. One strategy identified to address this is to increase the participation rates of Aboriginal registered nurses within the Australian healthcare workforce. Presently Aboriginal nurses account for only a small percentage of the nursing workforce. While there has been research into the recruitment and retention strategies dedicated to improving the numbers of Aboriginal registered nurses, this paper focus on the experiences of Aboriginal registered nurses within Australia's mainstream healthcare system, where they are exposed and subjected on a daily basis to the 'whiteness of nursing.' [ABSTRACT FROM AUTHOR]

Australia needs more Indigenous nurses. This is widely recognised in both academic literature and government policy. In 2012, only 0.8 percent of the Australian nursing workforce was Indigenous (AIHW, 2012). In spite of the clear need, there is little discussion about how to successfully recruit, retain and graduate Indigenous nursing students. This paper describes a successful programme being implemented at the University of Southern Queensland (USQ). Between 2000 and 2012, USQ graduated 80 Indigenous nurses and midwives, at both undergraduate and postgraduate levels. In this paper, the authors outline the journey they undertook to develop the successful programme at USQ: The Indigenous nursing support model: Helping hands. They argue that four elements underpin success for Indigenous nursing students: The availability of Indigenous academics, Indigenous health content in the nursing curriculum, Indigenous-specific recruitment materials, and individual mentoring and nurturing of Indigenous students. [ABSTRACT FROM AUTHOR]

Aims and objectives: This paper reports a study aimed at exploring the nursing practices associated with the administration of pro re nata (PRN) postoperative analgesia to children, and at gaining a preliminary understanding of the decisions that nurses make about this important intervention. Background: Nurses are responsible for assessing and administering the appropriate medication at the appropriate time to the child in pain. There was scant published research about the administration of postoperative PRN analgesia to children, or about the decision-making processes inherent in this aspect of clinical nursing care. Design: A sequential mixed methods explanatory study with two data collection phases -- quantitative followed by qualitative -- was conducted. Results: Nurses used multiple strategies to ascertain children's need for postoperative PRN analgesia, including reference to pain assessment tools, focussing on the behavioural cues of children, involving parents and children, and drawing upon personal and professional backgrounds and experience. Evaluation of the effectiveness of PRN postoperative analgesia was poorly communicated. Conclusions: Decision-making associated with the selection and administration of appropriate analgesia to children is complex. In-service education should be developed and offered to nurses working with children postoperatively to ensure the appropriate use of PRN pain relief. Relevance to clinical practice: Documentation surrounding this task is poor and needs to be addressed as a matter of urgency to ensure quality patient outcomes. [ABSTRACT FROM AUTHOR]

In 2009, a nursing education model was locally designed and delivered to support the interest of a group of Aboriginal community members living in a rural and remote town in Queensland, specifically to prepare for entry into further nursing education. Named 'Tjirtamai' by the traditional owners of the area, the program was offered in recognition of the challenges faced by Aboriginal people when they enter nursing education courses and as a way to increase the local number of Aboriginal nurses. This program, while funded by the Government, had unprecedented support and involvement from both the local Aboriginal and wider community. The model offered multiple exit points, assistance with financial and other known challenges for Aboriginal and Torres Strait Islander students, and included contextualised literacy and numeracy. Of the 38 Aboriginal students who enrolled in the course, 26 students completed. Of those students, 18 have since enrolled in a bachelor degree in nursing while another 4 enrolled in a diploma of nursing. This paper provides an overview of the course and its outcomes. [ABSTRACT FROM AUTHOR]

The provision of a well trained and culturally safe health workforce is critical to the alleviation of health inequities for Australian Indigenous peoples. Educating and graduating significant numbers of Indigenous registered nurses is one way the 'Close the Gap' initiative succeeds. Indigenous nurses bring a set of unique skills, knowledge and understanding to health service delivery. Their contribution has the potential to enhance future outcomes for Indigenous people by improving access to health services, ensure services are culturally appropriate and respectful, and assist non-Indigenous nurses to deliver culturally appropriate care. This paper discusses the background to the current numbers of Indigenous undergraduate nursing students enrolled in and completing tertiary nursing courses, with a focus on Queensland nursing programs. A range of identified barriers impede Indigenous nursing students' successful completion of their studies. We propose recommendations for education, research and employment to help overcome these problems, and ensure greater Indigenous participation in the nursing workforce. [ABSTRACT FROM AUTHOR]

The increasing number of people with dementia in aged care facilities is reported to have a high burden of care among staff. The Nurse Practitioner role can be beneficial in the provision of dementia care particularly when difficult and aggressive behaviour is being displayed. The model of service described in this paper is designed in such a way to make the outreach team contribute to staff sustainability. Such a service is different to other outreach services and focuses on a number of key deliverables. In practice, the service ensures that recommendations made by the team at the initial assessment are implemented. In addition, they work with the staff in managing the resident's behaviour, train and model suggestions for practice in interventions. Evaluation of the service is a work in progress and will highlight important aspects about the workforce for the improvement of quality of life for residents with dementia. [ABSTRACT FROM AUTHOR]

School nursing was introduced a century ago as part of a range of public health measures. However, the roles and responsibilities of school nurses varied considerably throughout the Western World. This paper explores these responsibilities during the early part of the twentieth century, with a particular emphasis on the role of school nursing in Queensland, Australia. While school nurses were initially employed to support the medical officers within the school setting, the school health system evolved to be essentially a nursing service. However, it was not a well resourced service. This meant there were unrealistic expectations placed on school nurses. Furthermore, because of the nature of the work undertaken by school nurses there were potential conflicts that needed to be negotiated on a daily basis between the nurse and the schools, parents, doctors and government departments. [ABSTRACT FROM AUTHOR]

Background: Postnatal care is best provided in primary health care settings, yet Practice Nurses (PNs) lack relevant training and report difficulty in providing postnatal care. Aim: To evaluate the feasibility of a pilot educational intervention in improving PN competence and confidence to care for mothers and infants in the first postnatal year. Design: A feasibility study. Methods: PNs were recruited from selected general practices Queensland, Australia to undertake the pilot educational intervention that included a pre-intervention survey, two-day education program, program evaluation and completion of a practice journal. Results: Thirteen PNs from three general practices participated, with 31% completing all study components. Evaluation of the intervention was positive and all participants reported increased confidence and competence in providing postnatal care. Following detailed consideration of feasibility (process, resource, management and scientific assessment) we propose that changes to intervention delivery and data collection should be incorporated into a larger trial. [ABSTRACT FROM AUTHOR]

Background: Aged care services and nursing roles are evolving in response to policy reform and increasing consumer expectations, however the nursing workforce is declining in numbers. Aims: To examine registered nurses' perceptions and experiences of working in aged care. Methods: Descriptive, exploratory study involving thematic analysis of individual interviews. Results: Key issues related to: professional role strain; workforce challenges; managing expectations, relationships and communication; balancing rights and risk in decision-making; changing models of care and impacts of policy and regulation. Conclusion: Expectations and perceptions of aged care nursing are unclear and conflicted. Nurses face significant challenges in meeting consumer, profession, organisational, and policy expectations amidst workforce instability and resource constraints. Structural barriers and aged care policy environments represent significant threats to sustaining nursing in aged care. [ABSTRACT FROM AUTHOR]

Background: Person-centred care is a policy priority for health services seeking to assure the public they provide safe, high-quality care, in keeping with rising consumer expectations. However, study of person-centred care rarely includes acute-care patients' perspectives. Methodology: In 2013, semi-structured interviews were held with 10 former patients of an Australian regional health service and examined via thematic analysis to understand patients' experiences of nursing care, interpret findings in the context of person-centred care principles and identify ways to enhance and support compassionate, person-centred care in everyday nursing practice. Results: Clinically competent care, delivered compassionately through a positive nurse–patient relationship, resulted in personal, emotional or spiritual responses that were the catalyst for patient empowerment and participation in care, and a positive outlook toward recovery. Implications for practice: Nurses wishing to implement person-centred care need to recognise the importance of prioritising human connection and compassion in conjunction with clinical competence. [ABSTRACT FROM AUTHOR]

Inadequate community housing and support for adults under 65 years with complex health needs often leads to residential aged care placement. In 2006, Australian government authorities funded a range of supported housing alternatives for younger adults requiring access to 24-hour support including the Integrated Living Model (ILM). The ILM provided purpose-built accommodation for 10–20 people and represented a change in practice from traditional 24/7 nursing care toward a more holistic, individualised approach. Aim: Examine workforce challenges in implementing disability service standards (DSS) within an ILM. Method: Thematic Analysis of workforce practices was conducted by coding staff interviews (n = 20) against the prevailing DSS. Results: Emerging challenges identified against each standard were: expectation management; coordination; client expertise; blurred boundaries; role confusion; valued status beyond client; unclear practice boundaries; multilayered communication; reflective practices; and mixed service model responses. Conclusion: This ILM setting requires workforce development in rights-based practice, personalisation and effective communication. Key paradigm shifts are also recommended. [ABSTRACT FROM AUTHOR]

Background: Nursing identity is an important element of being a nurse. Student nurses begin the construction of their nursing identity during their clinical placements. Aim: The aim of this research was to examine how the student nurses of a regional Australian university construct their identity when on off-campus clinical placement. Methods/Design: Using a constructivist approach an online survey was used to elicit data in response to the question 'What elements are needed during the work integrated learning experience to enable undergraduate nursing students to construct their nursing identity?' Results/Findings: Findings reveal five key elements to the construction of students' nursing identity; positive role models, belonging, peer support, critical thinking abilities and confidence. Conclusion: Such findings are important as they provide information for student nurses, preceptors and educators in guiding clinical placement experiences that are able to facilitate the development of the nursing identity. [ABSTRACT FROM AUTHOR]

Age-related hearing loss can impact adversely on the delivery of primary care and cannot necessarily be remedied by hearing aid technology. A study of 20 older Australians living in a Queensland retirement village and residential hostel complex was undertaken to investigate how communication might be advanced through an assistive listening device (ALD). Most participants were women aged over 85 years; almost all had hearing loss and wore hearing aids. Tests with an ALD found very high levels of satisfaction with understanding speech and sound quality amongst participants. However, few had heard previously of ALDs, all required individualised assistance to fit and use the device and rated ease of use less highly. The findings affirm those of previous studies that ALD technology has a role in communication for older hearing impaired people and for hearing rehabilitation. Its potential to enhance quality of life can be facilitated and promoted through nursing practice, but requires professional and consumer education so that it is not overlooked as a communication option. [ABSTRACT FROM AUTHOR]

Torres Strait Islanders living in the Torres Strait region have the highest prevalence of Type 2 diabetes in Australia; more than three times the rate of other Australians. Abdominal obesity and insulin resistance are the main causes for these high rates of the disorder. Further, Aboriginal and Torres Strait Islanders diagnosed with diabetes have poorer glycaemic control and much lower rates of insulin use than non-Indigenous Australians diagnosed with Type 2 diabetes alongside extremely high rates of renal failure and other comorbidities. Interventions have been instigated in order to overcome these issues. Previously a simple recall system managed by local health workers achieved significant improvements in diabetes care, reduced diabetes-related hospitalisations by 40% and led to the implementation of a chronic disease register and recall system throughout the Torres Strait region. Nurses, Indigenous health workers and other health professionals play important roles in ensuring these interventions continue. [ABSTRACT FROM AUTHOR]

Australian nurses and midwives are expected to compile a professional development portfolio during their annual registration process. This study aimed to ascertain the current understanding, practice and future continuing professional development (CPD) needs of nurses and midwives employed in a regional area of Queensland, Australia. Perceived barriers and incentives for CPD were also measured. 289 public and private hospital nurses and midwives responded to the survey. Results showed that participants understood the new requirements, valued ongoing learning, preferred education to occur within work hours, and considered their workplaces as accepting of change. Approximately two-thirds of participants believed CPD should be shared between them and their employers. Barriers to undertaking CPD included understaffing, and the concern that CPD would interfere with time outside work. Organisational support positively influenced attitudes to CPD. This study highlights the importance of supportive management in encouraging their workforce to embrace ongoing learning and change. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this research is to examine School Based Youth Health Nurses (SBYHN) experience of a true health promotion approach. Background: The School Based Youth Health Nurse Program is a state-wide school nursing initiative in Queensland, Australia. The programme employs more than 120 fulltime and fractional school nurses who provide health services in state high schools. The role incorporates two primary components: individual health consultations and health promotion strategies. Design/methods: This study is a retrospective inquiry generated from a larger qualitative research project about the experience of school based youth health nursing. The original methodology was phenomenography. In-depth interviews were conducted with 16 school nurses recruited through purposeful and snowball sampling. This study accesses a specific set of raw data about SBYHN experience of a true health promotion approach. The Ottawa Charter for Health Promotion (1986) is used as a framework for deductive analysis. Results: The findings indicate school nurses have neither an adverse or affirmative conceptual experience of a true health promotion approach and an adverse operational experience of a true health promotion approach based on the action areas of the Ottawa Charter. Conclusions: The findings of this research are important because they challenge the notion that school nurses are the most appropriate health professionals to undertake a true health promotion approach. If school nurses are the most appropriate health professionals to do a true health promotion approach, there are implications for recruitment and training and qualifications. If school nurses are not, who are the most appropriate health professionals to do school health promotion? Implications for practice: These findings can be applied to other models of school nursing in Australia which emphasises a true health promotion approach because they relate specifically to school nurses' experience of a true health promotion approach. [ABSTRACT FROM AUTHOR]

Endorsed Enrolled Nurses (EENs) articulating from diploma level to Bachelor of Nursing (BN) studies at university experience many transitional barriers. Flexible credit arrangements can create further difficulties because students may enter directly into the second year of a degree program, thus foregoing supportive interventions targeting first year students. This qualitative study explored the transitional barriers faced by EENs articulating to the second year of a BN program and the processes employed to adapt to the university learning environment. Lizzio's (2006) Five Senses of Success Model provided a framework for data analysis. Lizzio's model highlights how students' success at university depends on their sense of purpose, capability, resourcefulness, connectedness and academic culture. This study revealed EENs grapple with their dual identity, have difficulty reconciling their academic and clinical competence, and struggle to assimilate to the academic learning environment. Findings illuminate the importance of tailoring orientation and engagement activities to the specific transitional needs of articulating students. [ABSTRACT FROM AUTHOR]