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This study compares the humoral immune response of a cohort of renal transplant recipients (RTRs), in Trinidad & Tobago following two-dose primary immunization with non-mRNA vaccines amidst the COVID-19 pandemic. RTRs along with healthy, age-and gender-matched controls received either the adenoviral vector vaccine, AstraZeneca-Vaxzevria (AZ) or the inactivated vaccine, Beijing CNBG-BBIBP- CorV/Sinopharm (SP). Samples were taken after completion of a two-dose primary immunization during the period November 2021 to December 2021, at a mean interval of 138 days following immunization. 38/72 RTRs (53 %) failed to generate any protective antibody responses, compared with 7/73 participants, approximately 10 % in the healthy, age and gender-matched control group. In the RTRs, there was no significant correlation of their antibody concentration with either the timing of sample collection or the interval since transplantation. The study provides necessary information about the humoral response after two- doses of non-mRNA vaccines in a group of transplant recipients. [Abstract copyright: © 2024 The Author(s).]

How a woman experiences birth is influenced by how she is treated, and who has power and control in the birthing environment. Focus on 'delivery' of an infant disregards the transformative event for the woman, with poorer physical and psychological outcomes. New evidence is needed to understand how to prevent trauma and improve maternal wellbeing.This paper presents a feminist methodology to view the lived experience of caesarean birth. Feminist birthing theories integrated with a phenomenological perspective provide insight for those working in maternity care and create a novel framework for researchers considering the position of women in a medicalised healthcare system. Feminist phenomenology with a theoretical feminist overlay refreshes the methodological framework for a new understanding of how this perinatal event impacts women.

This chapter explores the links between practice development (PD) and critical social science (CSS). The political roots of PD reflect its radical and activist origins as practitioner-led enquiry guided by an emancipatory interest. The PD movement emerging in the 1980-1990s crystallised a new wave of critical-emancipatory scholarship in nursing. A facilitator working in the emancipatory worldview explores how workplace culture is shaped by the wider structures of power and dominant ideology. The chapter describes how CSS informed an aspect of practice within the study and how awareness of theory enabled the researcher to support staff to work through a crisis. At the core of PD there is an explicit focus on person centredness and the development of person-centred cultures. As a foundation of PD, CSS provides a framework for generating practitioners who understand identity as the basis of who they are and relationship as the connections to others in practice.

Background: Governments, health organisations and regulatory bodies across the world are making their expectations explicit: healthcare professionals and organisations should be providing person-centred care. Yet, it is still not common practice. Aims and objectives: This discussion article aims to explore some of the historical and current perspectives on the interrelated concepts of personhood and person-centred care, and to explain how the persistence of differing perspectives affects the way person-centred care is understood, implemented and evaluated. The article then aims to explain the need for person-centred cultures and practices, and to find a way to progress towards a person-centred agenda. Methods: To develop an understanding of the evolution of and current approach to these concepts, a literature search was undertaken. This included a broad search of the grey literature and the Medline and CINAHL databases, as well as review of articles published in the International Practice Development Journal, and a number of books and literature recommendations. Discussion: Multiple perspectives were found in relation to personhood and person-centred care. How personhood is viewed by healthcare staff and organisations has a direct impact on how person-centred care is delivered. Person-centred practice is a more inclusive concept as it advocates that staff should also experience person-centredness. However, to achieve sustainable person-centred practice, efforts may need to focus on investment in developing person-centred cultures at system and team levels. A person-centred framework can guide this change. Conclusion: Person-centred care is espoused within health policies, visions and mission statements. However, the focus should be on person-centred cultures and on how these can be developed and embedded. The Person-centred Practice Framework can aid understanding, implementation and evaluation of person-centred practice for all.

Aim and objectives To explore the thoughts and experiences of aged care nurses following participation in an ageing‐suit simulation intervention. Background Globally, people are living longer, and for nurses, there are increasing challenges to meet the needs of the higher numbers of older people in hospital. Educating nurses to understand the ageing process and the experiences of older people in hospital is crucial to addressing these challenges. Ageing‐suits were identified as a possible approach to assist with these educational needs. Design This study adopted a qualitative descriptive design. Method A convenience sample of nurses (n = 15) were selected from a single aged care ward. Volunteered nurses participated in a four‐hour ageing‐suit simulation session. Their immediate thoughts and experiences were explored via postsimulation debriefs, and three 30‐to 50‐min follow‐up focus groups were conducted at 3 months to explore perceptions on the impact of their experience on clinical practices. The data were analysed with the Braun and Clarke's six‐step thematic analysis method. To ensure quality reporting of this study, the COREQ checklist was utilised (see Appendix S1). Results Data analysis generated three main themes. Nurses in the study highlighted that the experience of the ageing‐suit resulted in “it feels real” (theme 1) and helped them in “enhancing understanding” (theme 2) about older people and their practices and supported a process of “changing me” (theme 3). Conclusion Ageing‐suits are emerging as a promising innovative educational approach for aged care nurses to gain insight into the challenges of ageing and subsequently making changes to themselves and their individualised practices towards older people. Future research is required to determine whether this educational approach is useful for a broader population of healthcare professionals. Relevance to clinical practice Ageing‐suits were identified as a worthwhile educational approach for aged care

Aims and objectives: To evaluate a bundle of interventions, developed and implemented by nurses, to reduce medication administration error rates and improve nurses’ medication administration practice. Background: Medication administration errors are a problematic issue worldwide, despite previous attempts to reduce them. Most interventions to date focus on isolated elements of the medication process and fail to actively involve nurses in developing solutions. Design: An Action Research (AR) three-phase quantitative study. Methods: Phase One aimed to build an overall picture of medication practice. Phase Two aimed to develop and implement targeted interventions. During this phase, the research team recruited six clinical paediatric nurses to be part of the AR Team. Five interventions were developed and implemented by the clinical nurses during this phase. The interventions were evaluated in Phase Three. Data collection included medication incident data, medication policy audits based on hospital medication policy and Safety Attitudes Questionnaire. Quantitative analysis was undertaken. The Standards for QUality Improvement Reporting Excellence (SQUIRE) checklist was followed in reporting this study. Results: Postimplementing the interventions, medication error rates were reduced by 56.9% despite an increase in the number of patient admissions and in the number of prescribed medications. The rate of medication errors per 1,000 prescribed medications significantly declined from 2014 to 2016. The ward nurses were more compliant with the policy in postintervention phase than preintervention phase. The improvement in SAQ was reported in five of the seven domains. Conclusion: Clinically based nurse's participation in action research enabled practice reflection, development and implementation of a bundle of interventions, which led to a change in nursing practice and subsequent reduction in medication administration error rates. Active engagement of nurses in research empow

OBJECTIVE: The aim of the study was to evaluate a technological solution in the form of an App to implement and measure person-centredness in nursing. The focus was to enhance the knowledge transfer of a set of person-centred key performance indicators and the corresponding measurement framework used to inform improvements in the experience of care. DESIGN: The study used an evaluation approach derived from the work of the Medical Research Council to assess the feasibility of the App and establish the degree to which the App was meeting the aims set out in the development phase. Evaluation data were collected using focus groups (n = 7) and semi-structured interviews (n = 7) to capture the impact of processes experienced by participating sites. SETTING: The study was conducted in the UK and Australia in two organizations, across 11 participating sites. PARTICIPANTS: 22 nurses from 11 sites in two large health care organizations were recruited on a voluntary basis. INTERVENTION: Implementing the KPIs and measurement framework via the APP through two cycles of data collection. MAIN OUTCOME MEASURES: The main outcome was to establish feasibility in the use of the App. RESULTS: The majority of nurse/midwife participants found the App easy to use. There was broad consensus that the App was an effective method to measure the patient experience and generated clear, concise reports in real time. CONCLUSIONS: The implementation of the person-centred key performance indicators using the App enhanced the generation of meaningful data to evidence patient experience across a range of different clinical settings.

The aim in this study was to understand current practice and use of nitrous oxide for management of procedural-related pain and procedural anxiety, to identify perceived barriers to use of nitrous oxide and to develop an understanding of patients, families, and nurse awareness and knowledge of the use of nitrous oxide in an Australian tertiary pediatric oncology/hematology short stay unit. Three online questionnaires (patients, parents, and nursing staff) were developed and completed between September and November 2015. Most children and young people (61%) report receiving nitrous oxide for at least one procedure. Patients, parents, and nurses rated nitrous oxide as highly effective and would like more access to nitrous oxide for the child's pain management. Several barriers to use were reported. These findings suggest that nitrous oxide is effective for pain management; however, its use is inconsistent. Findings can potentially develop standardized processes and improve nurse education and accreditation, which may increase the safety, efficacy, and utilization of nitrous oxide for children's procedural pain management.

Population ageing is a success story of our time. Unfortunately healthcare, especially in hospitals has been slow to adapt to the changing needs of the community.

Background and/or rationale: "Specialling" is a common nursing practice in hospitals which entails the allocation of extra staff to be with an older person who is confused to maintain safety. Despite ongoing use, this practice has little evidence of effectiveness. To facilitate further investigation, a concept analysis of "specialling" was undertaken. Aims: The aim of this paper was to report on a concept analysis on the practice of "specialling" pertaining to older people who have cognitive impairment when in hospital. Methods: This study used Rodgers evolutionary approach to concept analysis to clarify the attributes, antecedents and consequences of the concept to determine a definition of "specialling." Web of Science (Core Collection and Web of Science Medline), CINAHL and SCOPUS databases were searched to identify relevant literature. Due to the scarcity of papers, the search was broadened to include all sources that could add understanding. Findings: A total of (n = 43) sources were identified. The attributes were themed to 5 categories: Labels and descriptions; the "Special" role; Patient safety; Patient care; and Communication. The antecedents to 2 themes: Patient characteristics; and Organisational risk. The consequences of "specialling" were diverse with 6 themes: the "Special" role; the Older persons experience; Costly; "Special" use and nursing beliefs; Safety outcomes; and Opportunities. Discussion: The process of concept analysis provided a means to identify knowledge gaps and practice challenges. The definition determined from this analysis has provided a reflective opportunity for clinicians and researchers to consider when implementing care initiatives to support older people in hospital. Important is the lack of person-centred approaches and the opportunities in developing nurse leadership through empowerment. The findings from this analysis will inform a PhD study. Implications for practice: Nurses have an opportunity to lead care improvements by

presented at the 11th International Association of Gerontology and Geriatrics Asia/Oceania Regional Congress, 23-27 October 2019, Taipei, Taiwan

Background: The global acceptance and use of technology in health care has resulted in an abundance of mobile health (mHealth) applications (apps) available for use in the delivery and improvement of care. With so many apps available to patients and clinicians, it is important to understand how data from apps are being used to inform quality improvement in practice. Aim: The aim of this integrative review is to establish current knowledge of how mHealth apps are used to produce data to inform quality improvement in health care. Methods: Scopus, Web of Science, CINAHL, and Medline Plus Full Text databases were searched for peer-reviewed papers written in English. The inclusion criteria comprised of full-text, empirical research studies relating to mobile health application use (not development) in clinical care. Results: Nineteen studies met inclusion criteria. The functions of the apps outlined in the studies can be summarized into four different categories: communication, illness management, clinical management, and education/information. The types of data collected by the apps included numerical, textual, photographic, and graphical with several apps able to collect a variety of data types. Analysis of the studies showed that although data collection is rarely outlined as the explicit purpose of mHealth apps, data collected through such technology are and can be used to inform practice change both in real time and retrospectively. Linking Evidence to Action: This review highlights while this is an emerging area, data obtained from mHealth apps can and are being used to inform quality improvement in health care. Further research is required in this area to adequately understand how data from mHealth apps can be used to produce quality improvement, specifically in relation to nursing. This review also highlights a need for the development of apps that aim to capture data to inform quality improvement, particularly from the patient perspective.

Using data from the Health, Aging, and Body Composition study, we examined whether low 25-hydroxyvitamin D (25[OH]D) concentrations were associated with prevalent or incident cognitive impairment. Serum 25(OH)D concentrations were measured in 2,786 older adults and categorized as <20 ng/mL, 20 to <30 ng/mL, or ≥30 ng/mL. Cognitive impairment was defined as a score >1.5 standard deviations below race and education specific means on either digit symbol substitution test or modified mini-mental state test. Logistic regression determined the odds of cognitive impairment at baseline and year 5 by 25(OH)D category. 25(OH)D concentrations were <30 ng/mL in 57.3% of whites and 84.6% of blacks. After excluding participants with baseline cognitive impairment (n = 340), 13% of whites and 13% of blacks developed cognitive impairment by year 5. In whites, 25(OH)D concentrations <30 ng/mL were not associated with prevalent or incident cognitive impairment. Black participants with 25(OH)D concentrations <20 ng/mL had a higher odds of prevalent, but not incident cognitive impairment (OR (95% CI): 2.05 (1.08-3.91), p = 0.03) compared to participants with 25(OH)D concentrations ≥30 ng/mL. Low 25(OH)D concentrations were associated with twofold higher odds of prevalent cognitive impairment in blacks.

Poster presentation from the 8th Biennial Australia and New Zealand Falls Prevention Conference, 18-20 November 2018, Hobart, Australia.

There is recognition that working in the aged care setting can be physically and psychologically demanding, stressful and can lead to staff burnout. These types of demands can result in reduced job satisfaction, disengaged staff and can be detrimental to care delivery. In order to address these issues in a 52 bed sub - acute geriatric hospital within Australia, a self-care program was initiated to support staff wellbeing. The staff (nursing, allied health, managers, security staff) themselves were engaged in co-designing the self-care program alongside the project team. The Wellness Wednesday program runs for 45-60mins every Wednesday for eight weeks and includes a variety of self-care strategies e.g. yoga, reflexology, mindfulness and gratitude. There is wide recognition that strategies such as mindfulness can enable healthcare staff to work with compassion in stressful and demanding work environments, improving listening to others, being more present, less judgmental and more considerate of others perspectives. All staff within the hospital were invited to participate in the eight sessions. Each eight week program caters for 10-12 multidisciplinary team members. Throughout the study participants were supported to 'IMAGINE' how the care environment could be enhanced to support the well-being of all staff, suggestions for improvement were captured and submitted to the Imagine committee for consideration. In addition staff were encouraged to use the techniques they were learning with their colleagues and where appropriate with patients (e.g. providing simple hand massage). In this presentation we will share the results of this mixed-methods intervention study including what worked well, how the strategies impacted on improved participant well-being and promoting a healthy workplace culture. Highlighting improvements in staff engagement, job satisfaction, workplace wellbeing and reduced intention to leave. We will also offer insights into how you could use the Imagini

ObjectivesTo examine the relationship between 25-hydroxyvitamin D (25(OH)D) levels and cognitive performance over time in older adults in the Health, Aging and Body Composition (Health ABC) Study.DesignProspective cohort study.SettingCommunity-dwelling participants in Pittsburgh, Pennsylvania, and Memphis, Tennessee.ParticipantsWell-functioning adults aged 70 to 79 at baseline with serum 25(OH)D measured at the 12-month follow-up visit and cognitive function measured at baseline and 4-year follow-up visit (N = 2,777).MeasurementsVitamin D status was categorized as 25(OH)D levels of less than 20.0 ng/mL, 20.0 to 29.9 ng/mL, or 30.0 ng/mL or greater. Cognition was measured using the modified Mini-Mental State Examination (3MS) and Digit Symbol Substitution Test (DSST). Linear regression models adjusting for multiple covariates, including age, education, sex, race, site, season, physical activity, and comorbidities, were used in the analysis.ResultsSixty-eight percent of participants had 25(OH)D levels of less than 30.0 ng/mL. Lower 25(OH)D levels were associated with lower baseline cognitive scores on the 3MS (adjusted mean 89.9, 95% confidence interval (CI) = 89.4-90.4 for <20.0 ng/mL; adjusted mean 90.8, 95% CI = 90.4-91.3 for 20.0-29.9 ng/mL; adjusted mean 90.6, 95% CI = 90.2-91.1 for ≥ 30.0 ng/mL; P trend = .02) and the DSST (adjusted mean 35.2, 95% CI = 34.5-36.0 for <20.0 ng/mL; adjusted mean 35.9, 95% CI = 35.2-36.6 for 20.0-29.9 ng/mL; adjusted mean 37.0, 95% CI = 36.3-37.8 for ≥ 30.0 ng/mL; P trend = .01). Participants with low 25(OH)D levels had greater declines in 3MS scores over 4 years than those with higher levels (least square mean change -1.0, 95% CI = -1.5 to -0.6 for <20.0 ng/mL; least square mean change -0.8, 95% CI = -1.2 to -0.3 for 20.0-29.9 ng/mL; least square mean change -0.2, 95% CI = -0.7 to 0.2 for ≥30.0 ng/mL; P = .05). There was no significant difference in DSST decline according to 25(OH)D level.ConclusionLow 25(OH)D levels were

This study aims to outline the current workplace culture of medication practice in a pediatric medical ward. The objective is to explore the perceptions of nurses in a pediatric clinical setting as to why medication administration errors occur. As nurses have a central role in the medication process, it is essential to explore nurses' perceptions of the factors influencing the medication process. Without this understanding, it is difficult to develop effective prevention strategies aimed at reducing medication administration errors. Previous studies were limited to exploring a single and specific aspect of medication safety. The methods used in these studies were limited to survey designs which may lead to incomplete or inadequate information being provided. This study is phase 1 on an action research project. Data collection included a direct observation of nurses during medication preparation and administration, audit based on the medication policy, and guidelines and focus groups with nursing staff. A thematic analysis was undertaken by each author independently to analyze the observation notes and focus group transcripts. Simple descriptive statistics were used to analyze the audit data. The study was conducted in a specialized pediatric medical ward. Four key themes were identified from the combined quantitative and qualitative data: (1) understanding medication errors, (2) the busy-ness of nurses, (3) the physical environment, and (4) compliance with medication policy and practice guidelines. Workload, frequent interruptions to process, poor physical environment design, lack of preparation space, and impractical medication policies are identified as barriers to safe medication practice. Overcoming these barriers requires organizations to review medication process policies and engage nurses more in medication safety research and in designing clinical guidelines for their own practice.

The concept of person-centred practice provides nurses with a framework for undertsanding the complexity of the health-care setting. It is applicable across differing care contexts (from acute care to rehabilitation to care within the home), and flexible enough to take into account the needs of patients of all ages. At its heart is the need for those who work in such contexts to focus on delivery of care that achieves outcomes that benefit the patient, their family and themselves. Providing such care not only nurtures the patient and supports the family, but also ensures staff invest in creating care cultures that result in improved well-being for all. The creation of effective person-centred cultures is neither easy or straightforward; it requires a common vision and goals, strategic planning, systematic approaches, supportive leadership, tenacity and dedication. In this chapter we will be sharing with you how one organsiation has developed Person-Centred Paediatric Practice as the foundation for nursing.

Background: There is a large and diverse literature on the concept of hope in health care. This literature covers a broad spectrum of perspectives, from philosophical, conceptual, and theoretical analysis through to attempts at measuring the concept of hope with differing health care users. Aims: To explore the concept of hope through the secondary analysis of existing data sets, with the intention of understanding hope in the context of person-centeredness. Research Question: What is the experience of hope among service users and informal carers in different health care contexts? Method: Secondary analysis of data derived from three research studies. Findings: We identified four key themes that together illustrate what we describe as a kaleidoscope of hope, reinforcing the view that there is no one presentation of hope and that practitioners must engage authentically with service users to determine the most effective and appropriate intervention strategies. Conclusions: Hope is not a singular phenomenon, and in the context of person-centered practice there is a need for practitioners to engage authentically with service users and listen carefully to what may bring hope for them.

There has been significant work in better managing health-care services as costs in service delivery escalate due to advances in science and technology, an ageing population, and new and emerging diseases requiring increased access to health care. This has occurred without the expected reciprocal increase in quality and safety of care. In addition it has been recognised that the traditional approaches to health-care planning and delivery do not necessarily meet the needs of consumers, are often fragmented, result in waste within the health-care system and do not reflect best practice.

Background: Reflective practice is now widely used as a critical learning tool in undergraduate and postgraduate nursing programs in most developed countries. However in developing countries, reflective practice is in its infancy. Aim: To introduce reflective practice to postgraduate students in an Indonesian nursing education institution. This paper presents the positive meanings of reflection and reflective practice experienced by the students and the way they used reflection within their practice. Design: A descriptive qualitative study was conducted to explore the meaning of reflection or reflective practice using flashcards. Method: A clinical reflective practice model taking into consideration Indonesian culture was developed and applied during students' clinical placement. A few weeks post clinical placement, 21 students participated in an evaluation session. The meaning of reflection or reflective practice was explored using flash cards containing images of people and environment with different situations and events. Students were asked to choose a card that represented their viewpoints about reflective practice and share it with the group. Data were digitally captured and analyzed using thematic analysis. Findings: Reflection provided a positive experience for the students. In their own words, they discussed their journey of using reflection during the clinical placement period. The use of reflection was identified as expanding their view of nursing practice, providing a safe place to explore their experiences and clarity when they encountered challenging situations during their clinical practice. Reflecting on practice experiences resulted in increased self-awareness, and enhanced their learning. Conclusion: The findings indicate that reflective practice can be implemented successfully in Indonesia and may have value for other Eastern countries that share similar cultural characteristics. The use of flash cards assisted the students describe through storie

Aims and objectives: The aim of the Paediatric International Nursing Study was to explore the utility of key performance indicators in developing person-centred practice across a range of services provided to sick children. The objective addressed in this paper was evaluating the use of these indicators to benchmark services internationally. Background: This study builds on primary research, which produced indicators that were considered novel both in terms of their positive orientation and use in generating data that privileges the patient voice. This study extends this research through wider testing on an international platform within paediatrics. Design: The overall methodological approach was a realistic evaluation used to evaluate the implementation of the key performance indicators, which combined an integrated development and evaluation methodology. Methods: The study involved children's wards/hospitals in Australia (six sites across three states) and Europe (seven sites across four countries). Qualitative and quantitative methods were used during the implementation process, however, this paper reports the quantitative data only, which used survey, observations and documentary review. Results: The findings demonstrate the quality of care being delivered to children and their families across different international sites. The benchmarking does, however, highlight some differences between paediatric and general hospitals, and between the different key performance indicators across all the sites. Conclusions: The findings support the use of the key performance indicators as a novel method to benchmark services internationally. Whilst the data collected across 20 paediatric sites suggest services are more similar than different, benchmarking illuminates variations that encourage a critical dialogue about what works and why. Relevance to clinical practice: The transferability of the key performance indicators and measurement framework across different settings has

Background: Medication error is the most common adverse event for hospitalised children and can lead to significant harm. Despite decades of research and implementation of a number of initiatives, the error rates continue to rise, particularly those associated with administration. Objectives: The objective of this literature review is to explore the factors involving nurses, families and healthcare systems that impact on medication administration errors in paediatric patients. Design: A review was undertaken of studies that reported on factors that contribute to a rise or fall in medication administration errors, from family, nurse and organisational perspectives. The following databases were searched: Medline, Embase, CINAHL and the Cochrane library. The title, abstract and full article were reviewed for relevance. Articles were excluded if they were not research studies, they related to medications and not medication administration errors or they referred to medical errors rather than medication errors. Results: A total of 15 studies met the inclusion criteria. The factors contributing to medication administration errors are communication failure between the parents and healthcare professionals, nurse workload, failure to adhere to policy and guidelines, interruptions, inexperience and insufficient nurse education from organisations. Strategies that were reported to reduce errors were doublechecking by two nurses, implementing educational sessions, use of computerised prescribing and barcoding administration systems. Yet despite such interventions, errors persist. The review highlighted families that have a central role in caring for the child and therefore are key to the administration process, but have largely been ignored in research studies relating to medication administration. Conclusions: While there is a consensus about the factors that contribute to errors, sustainable and effective solutions remain elusive. To date, families have not been included as key

Most families can access a range of health information and advice. Information and advice sources often include nurses, the Internet, social media, books, as well as family and friends. While the immediate aim may be to find information, it can also be to assist with parenting skills, solve parenting problems or as part of decision-making processes about their child's health. These processes are strongly influenced by the parent's level of health literacy. Health literacy describes a person's capacity to obtain and utilize health related information. Although there are numerous health literacy definitions all have clearly defined steps. These steps are: obtaining relevant information; then understanding this information; and finally being able to use the information to achieve the expected outcome. Previous research has linked low levels of parental health literacy with poorer child health outcomes. Given this link, increasing health literacy levels would be advantageous for both families and health services. Nurses working with families are in a position to support the family to increase their health literacy through the use of a variety of strategies. This article outlines how health literacy can influence the way parents seek help when they are concerned about child health issues, the relevance of parental health literacy for nurses and suggests some tools that could be used to support the increase of health literacy.

Aims: To examine how results and data from multiple Family Centred Nursing Index surveys help the development of family-centred nursing at organizational and ward levels. Design: A critical analysis of survey data. Background: The Family Centred Nursing Index provides a valid and reliable assessment of aspects of nursing, through a comprehensive survey of traditional indicators of practice development and a broader range of aspects of practice. Methods: A survey with 113 questions, each to be answered on 7-point Likert scale conducted six times in the last 7 years. Surveys have been in 2006, 2008, 2009, 2010, 2011/2012 and 2012/2013. All nurses employed by the organization can participate. Results: These are reported as means across 19 constructs linked to five key domains and their significance is examined by year and (in the clinical settings) and compared against the organizational (whole population) averages. Ongoing survey and analysis of nurses' views of their work is providing a valuable source of developmental data. The results show unexpected associations between constructs e.g. - a high level of work stress does not correlate with a lower level of job satisfaction (and vice versa). A clear historical picture of many elements of developing family-centred care is emerging at both the organizational and individual-ward levels. Conclusion: This study provides insights into aspects of organizational and wards working environment for nurses and how these aspects of nurses' work interact in unexpected ways. It is appropriate for providing information to organizations and ward teams in relation to their development towards family-centred cultures.

Systemic consultation is a form of tertiary case supervision derived from the principles of systemic family therapy. The present study defines the process and outcomes of systemic consultation through the experiences of case managers (CMs) working with people who have an intellectual disability. CMs were invited to present and discuss one of their complex cases with a team of consultants and attend a follow up session 4 to 6 weeks later. Measures of levels of stress, perception of workplace functioning, and workflow information were completed pre and post-intervention and compared to measures completed by a second group of CMs receiving regular supervision only. After participation in systemic consultation, the networks of people CMs consulted about the case were significantly smaller and they scored significantly higher on a network measure of efficiency of information flow. The CMs experienced lower levels of stress and higher perception of workplace functioning, these differences approached significance. After attending the consultation outcome, themes included a reduced sense of being stuck and stressed, becoming an agent of change and taking perspective. The approach allows CMs space for reflection on practice and new perspectives to be heard. Case management has been under-represented in documented research and evidence-based training and supervision models, and is an area in which professional theory appears to be lacking.

Aims and objectives: To present survey findings on parental experiences with a hospital-based bead programme for children with congenital heart disease. Background: The Heart Beads programme commenced at a paediatric hospital in Australia in 2008. Children enrolled in the programme are awarded a distinctive bead for every procedure/treatment they have while in hospital. A previous evaluation study on the programme revealed that the beads are therapeutic for the child and parents; however, due to a small sample size, the results were representative of the experiences of a small number of families who participated in the programme. Design: This was an evaluation study which employed a nonexperimental descriptive design. Methods: Surveys were mailed to all eligible families who enrolled in the programme. Data collection occurred between July-December 2012. Questions on parental experiences with the Heart Beads programme were divided into three categories: understanding, acknowledgement and quality. Descriptive statistics were obtained and analysed. Results/findings: One hundred and sixty-two mothers and 136 fathers responded to the survey. Heart Beads assisted mothers (83%) and fathers (80%) with understanding their child's condition and helped them with communication (mothers 80%, fathers 58%). The majority of fathers felt that their experience was acknowledged by nursing staff (64%) and medical staff (62%), while mothers indicated a higher response from nurses (76%) compared to medical staff (67%). Overall, parents rated the programme positively; however, there was some concern that children at times missed out on beads. Conclusion: Understanding how mothers and fathers experience the programme differently can guide staff in their communication with parents and inform future initiatives. Relevance to clinical practice: The Heart Beads help nurses understand how parents are experiencing care and ways in which they can provide support and acknowledgement of the parent'

A significant obligation still rests with practitioners and researchers to help spread an understanding - and ultimately a valuing - of person-centred practice among stakeholders at various levels, through systematic and meaningful evaluation of their efforts. While there is a range of frameworks (for example, Praxis and Fourth Generation Evaluation) that help guide the evaluation process, there is still the tendency to feel overwhelmed by choices when selecting the right tools or measures for the right people at the right time. In addition, a burden may be created by the amount and range of data produced and how this is analysed and used, which may result in incomplete, inadequate or incongruous evaluations. If we are unable to provide evidence of the effectiveness of our evaluations then stakeholders may assume practice development does not make much difference to the development of an effective person-centred culture. This paper focuses on the importance of evaluation in practice development work and outlines a new framework that incorporates the principles of person-centred practice. This framework will assist practitioners and researchers to undertake effective evaluations and produce strong, reliable evidence for key stakeholders. A case example will be outlined to illustrate the key principles of the framework and how it can be used in practice.

Nurses are a critical part of the healthcare workforce and provide a significant proportion of care. There is a recognised gap in the evidence base regarding how to measure the impact of care and its contributions to the quality of the patient and family experience. This paper focuses on a set of eight key performance indicators (KPIs), developed from primary research led by a team at Ulster University to reflect core aspects of person-centred practice. The KPIs, having already been tested across a range of practice settings, are currently being implemented and further tested through an international study in the area of paediatrics. This study set out to explore their utility in supporting the development of person-centred practice across a range of services provided to sick children. The study involves children's wards/hospitals in Australia (six sites across three states) and Europe (seven sites across four countries). Its purpose is twofold: To describe the person-centred KPIs and how they link to the person-centred nursing framework 2. To describe how these KPIs are being further tested internationally across children's services,and the benefits and challenges of this international approach

College access has now become a necessary path toward prosperity and the middle class. In this follow-up article, the authors explore and define the characteristics of the typical African American student and make specific recommendations that will improve their postsecondary access, retention and completion. These solutions center on the Pell Grant, which provided financial aid to over nine million students in 2011- 2012, including 62 percent of all African American college students.

Reflective practice is a well-established concept in the education of professionals (Boud, 2010). The ability to reflect in and on practice is recognized as a crucial professional skill (Schön, 1987). Reflective practice is identified as assisting bridge the theory-practice gap by connecting what is taught about a theory and what is delivered in practice (Asselin, 2011) enabling the linking and reinforcement of theoretical and practical knowledge (Hatlevik, 2012). Reflective practitioners make this possible by utilizing a cyclical learning process; reflecting on past experiences in order to gain new knowledge about their practice and themselves as nurses (Johns and Watson, 2000).

Aim: To describe a process for mapping current practice within the neonatal intensive care unit (NICU) to inform practice change. There are evidence based recommendations for practices concerning neonatal pain. Despite these guidelines, there continues to be poor utilisation of evidence to guide pain assessment and management in the NICU. Methods: This study mapped current practices for postoperative pain assessment and management in one surgical NICU. Patient records of postoperative neonates were examined using a retrospective chart review to determine if knowledge was transferred into practice through compliance with clinical practice guidelines. Results: Compliance with the clinical guideline was poor. Pain assessments were under-recorded for the five days following surgery. There were no differences for preterm, wound location or type of surgery (p > 0.05). The mean duration in hours of opioid infusions varied, fentanyl (63 - range 11-117) and morphine (37 - range 5-106). In 50% the opioid was ceased with extubation. Weaning practices were inconsistent, an opioid weaning score was attended in less than 30% of neonates. Conclusions: Despite the availability of clinical practice guideline, pain practices remain inconsistent; however, improved compared to previous studies. Recommendations following this study include raising awareness about postoperative pain, revising the guideline and providing education for pain management techniques.

REACH is an international research collaboration between The Royal Hospitals in Belfast, Northern Ireland, and the Sydney Children's Hospitals Network and the Prince of Wales Hospital in Sydney, Australia. It's an integrated professional and practice development (PD) program for individual nurses that focuses on work-based learning, which helps transform care by creating the basis of developing self-knowledge and awareness through structured reflection about the impact of our actions on others in our workplace. Developmental processes and frameworks are beneficial to nurses in a number of facets, including accountability, cost-effectiveness, and quality improvement. We analyze the experiences of nurses in the Sydney Children's Hospital Network who were in the preliminary stages of implementing REACH at the time of evaluation. The program commenced in 2005 and is being rigorously and systematically evaluated both locally and internationally, using a realistic evaluation framework.

This research focused on exploring the experience of fifteen families who attended a first session of systemic family therapy, with reflecting team feedback being delivered in two different formats. In the first the interviewer consulted with the reflecting team alone after the therapy session while the family took a break and then provided feedback directly to the family. In the second the interviewer and family exchanged rooms straight after the session and the reflecting team provided feedback in conversation with each other. Families in both conditions of systemic family therapy described how the presence of a team led to a heightening of their emotion in session, a factor that served to effect a change in family interaction. For families in the first condition the consultation break reduced these intense emotions and provided a unique opportunity to continue independent discussions outside the therapy room. In contrast, those in the second condition reported that their experience was more exciting but it made information retention difficult. For this reason, the use of a therapeutic letter with this group was a crucial aspect of follow-up intervention.

Aim: The aim of this paper is to describe the use of Facebook for recruitment of parents for diabetes research. Method: An online self-administered questionnaire was designed in Survey Monkey and was available via a dedicated Facebook page. Data was collectedfrom parents (66) of children with type 1 diabetes attending an Australian primary school (kindergarten-Year 2). Results: 84 people "liked" the Diabetes at school Facebook page. 781 people were directly reached in Australia. The page was predominately accessed by females (78%), aged 35-44 years (34%) and 25-34 (29%). The two major cities in Australia were Melbourne, Victoria (94) and Sydney, NSW (83). The diabetes at school Facebook page was visited frequently during early February and the highest number of views in one day was 50. Conclusion: The key benefits of using Facebook to recruit parents for diabetes research were; the ease of use, increased access, cost saving and immediate collection of data.

Purpose: The purpose of this study was to explore the management of type 1 diabetes in Australian primary schools (Kindergarten to Year 2), from the parent's perspective. The study aimed to explore the concerns of parents regarding diabetes management in the school setting and the strategies needed to improve diabetes management in the school setting. Method: A cross sectional, descriptive approach was used to collect data from parents (n = 66) of children with type 1 diabetes attending an Australian primary school (Kindergarten to Year 2). An online self-administered questionnaire was designed in Survey Monkey and was available via a dedicated Facebook page. Qualitative data from the questionnaire were analysed using thematic analysis adapted from grounded theory coding. Quantitative data were statistically analysed using the Statistical Package for the Social Sciences (SPSS) version 21. Results: Parental concerns included difficulties with participation in school activities, inclusion at meal times, lack of independence and missing school due to fluctuating blood glucose levels (BGLs) or lack of full staff support. Children often missed classroom activities or time with peers when they had to attend the office for routine care. Safety was also a problem at school and many parents expressed the importance of adult assistance during fluctuating BGLs and easy access to hypo treatment. Two strategies for improving diabetes management at school were education of school staff and allocation of appropriate school staff support. Conclusion: Difficulty with participation in school activities is a common concern among parents of children with diabetes. In order for the child to experience a safe inclusive school environment, the appropriate level of education, staffing and ongoing support is required.

Background Change agency in its various forms is one intervention aimed at improving the effectiveness of the uptake of evidence. Facilitators, knowledge brokers and opinion leaders are examples of change agency strategies used to promote knowledge utilization. This review adopts a realist approach and addresses the following question: What change agency characteristics work, for whom do they work, in what circumstances and why? Methods The literature reviewed spanned the period 1997-2007. Change agency was operationalized as roles that are aimed at effecting successful change in individuals and organizations. A theoretical framework, developed through stakeholder consultation formed the basis for a search for relevant literature. Team members, working in sub groups, independently themed the data and developed chains of inference to form a series of hypotheses regarding change agency and the role of change agency in knowledge use. Results 24, 478 electronic references were initially returned from search strategies. Preliminary screening of the article titles reduced the list of potentially relevant papers to 196. A review of full document versions of potentially relevant papers resulted in a final list of 52 papers. The findings add to the knowledge of change agency as they raise issues pertaining to how change agents’ function, how individual change agent characteristics effect evidence-informed health care, the influence of interaction between the change agent and the setting and the overall effect of change agency on knowledge utilization. Particular issues are raised such as how accessibility of the change agent, their cultural compatibility and their attitude mediate overall effectiveness. Findings also indicate the importance of promoting reflection on practice and role modeling. The findings of this study are limited by the complexity and diversity of the change agency literature, poor indexin

Background: Reflection-in-action, or the capacity to "think on your feet" is recognised as a critical skill for clinical psychologists, but challenging for trainees who may cope poorly with ambiguity and be consumed by anxiety. This study aims to explore the in-session reflective capacity of trainees and identify their training needs. Method: Twenty seven episodes of therapy conducted by 10 trainees were collected using Interpersonal Process Recall. Data analysis was conducted according to the principles of grounded theory. Results: Trainees became distressed when their planned interventions did not match with the complexity of the client or account for challenging interpersonal interactions. Trainees could acknowledge this distress and still engage in fleeting and rudimentary reflection, but many, lacking sufficient technical knowledge or confidence, retreated to the safety of non-directive counselling. Conclusion: These findings support the development of a systematic approach to teaching reflective practice in clinical training.

Aims: To provide an overview of the development, implementation and process evaluation of a programme for nurses seeking to develop the knowledge and skills required to facilitate practice innovation. Method: The 12 month facilitation in clinical practice programme was underpinned by transformational practice development (tPD) methodology. The programme included a series of workshops, active learning groups and was supported by experienced facilitators, using a co-facilitation model. Evaluation occurred continuously throughout the programme. Results: Participants evaluated the programme positively and were able to apply their evolving knowledge and skills within their everyday practice. Their major areas of learning included active participation in their own learning, an increased valuing of diversity within the group and application of their learning in facilitation of practice development initiatives. The co-facilitation model was found to challenge and support ongoing development of the facilitators. Conclusions: Participation in the facilitation in clinical practice programme enhances nurses' knowledge and skills for undertaking tPD.

An ongoing survey tool, the Person Centred Nursing Index (PCNI), measures factors that affect nurses' job satisfaction. Results can be used to improve work environment and patient-centred care. This article describes how establishing the survey requires co-operation between managers overseeing the project and ward-based nurse leaders. It explores two examples of how nurse leaders have used the information to gain insight into how staff perceive their work and to address concerns raised.

Purpose: The aim of the leadership development program was to enhance participants' understanding of person-centered leadership in the context of their nursing unit manager (NUM) roles. Materials and methods: This article details the results of the NUM leadership development program (LDP). Twenty-one NUMs from an Australian pediatric hospital participated in the 8-month program. The evaluation encompassed a group claims/concerns/issues session, one-on-one interviews, and written feedback. Data were themed using a four-step sequential process. Results: The NUM LDP had a positive impact on the leadership practices of the participants. Six key themes were identified from the evaluation: "forming the group"; "being in the group"; "translating into practice"; "how we see ourselves; how do we want to be seen?"; "positive outcomes for me"; and "positive outcomes for others". Conclusion: This study showed improvements in the leadership understanding and practice of NUMs who participated in the program. Further research, particularly into the transferability of skills and active participatory aspects of these types of evaluation studies, is required.

Type 1 diabetes is one of the most common chronic health conditions in childhood. The introduction of intensive insulin therapy and the rising prevalence of diabetes in younger children has increased the need for involvement of diabetes educators and school personnel in school diabetes care. School encompasses a significant proportion of a child's day, therefore diabetes treatment at school needs to be optimal or the child will have poor metabolic control. The aim of this literature review is to examine diabetes management in the early primary school setting. The main areas of diabetes management explored are: type, provision, and location of treatment, the impact on the child, and the role of the credentialed diabetes educator. The review identifies that the majority of children are not receiving intensive diabetes treatment at school. Younger children require more assistance with care and may be disadvantaged due to lack of appropriate school staff support. Most schools do not have nurses to assist with diabetes care, therefore teaching and administration staff are utilized. The use of insulin pump therapy may increase access to insulin at school, as children and teaching staff appear more confident with this method of delivery than injections. Treatment is frequently performed away from the classroom and can impact on class attendance, metabolic control, and emergencies. Diabetes educators need to work in collaboration with children, parents, and school personnel to ensure diabetes care is fully integrated into the school day

Valerie Wilson,1,2 Sheree Paterson,3 Kelly Kornman1 1Nursing Research and Practice Development Unit, The Children’s Hospital at Westmead, Westmead, NSW, Australia; 2Faculty of Nursing Midwifery Health, The University of Technology, Sydney, Broadway, NSW, Australia; 3Formerly of the Nursing Research and Practice Development Unit, The Children’s Hospital at Westmead, Westmead, NSW, Australia Purpose: The aim of the leadership development program was to enhance participants’ understanding of person-centered leadership in the context of their nursing unit manager (NUM) roles. Materials and methods: This article details the results of the NUM leadership development program (LDP). Twenty-one NUMs from an Australian pediatric hospital participated in the 8-month program. The evaluation encompassed a group claims/concerns/issues session, one-on-one interviews, and written feedback. Data were themed using a four-step sequential process. Results: The NUM LDP had a positive impact on the leadership practices of the participants. Six key themes were identified from the evaluation: “forming the group”; “being in the group”; “translating into practice”; “how we see ourselves; how do we want to be seen?”; “positive outcomes for me”; and “positive outcomes for others”. Conclusion: This study showed improvements in the leadership understanding and practice of NUMs who participated in the program. Further research, particularly into the transferability of skills and active participatory aspects of these types of evaluation studies, is required. Keywords: nurse, evaluation, person-centered care, experiential learning

Background Realist synthesis is an increasingly popular approach to the review and synthesis of evidence, which focuses on understanding the mechanisms by which an intervention works (or not). There are few published examples of realist synthesis. This paper therefore fills a gap by describing, in detail, the process used for a realist review and synthesis to answer the question 'what interventions and strategies are effective in enabling evidence-informed healthcare?' The strengths and challenges of conducting realist review are also considered. Methods The realist approach involves identifying underlying causal mechanisms and exploring how they work under what conditions. The stages of this review included: defining the scope of the review (concept mining and framework formulation); searching for and scrutinising the evidence; extracting and synthesising the evidence; and developing the narrative, including hypotheses. Results Based on key terms and concepts related to various interventions to promote evidenceinformed healthcare, we developed an outcome-focused theoretical framework. Questions were tailored for each of four theory/intervention areas within the theoretical framework and were used to guide development of a review and data extraction process. The search for literature within our first theory area, change agency, was executed and the screening procedure resulted in inclusion of 52 papers. Using the questions relevant to this theory area, data were extracted by one reviewer and validated by a second reviewer. Synthesis involved organisation of extracted data into evidence tables, theming and formulation of chains of inference, linking between the chains of inference, and hypothesis formulation. The narrative was developed around the hypotheses generated within the change agency theory area. Conclusions Realist synthesis lends itself to the review of complex interventions because it accou

This paper presents three research case studies of children who have had surgery for a cardiac condition and discusses the experiences of the children and their families through their responses to the Heart Beads programme, as well as the insights gained by staff. The Children's Hospital at Westmead has a significant population of children with cardiac conditions. For many of these, diagnosis signals the beginning of a long, arduous journey with multiple procedures and admissions. The hospital has a family-centred care focus, and the cardiac ward undertook a project to implement and progress changes consistent with this approach. Staff developed the Heart Beads programme to enhance the care of children being treated for cardiac conditions. The programme involves children receiving distinct beads specific to each cardiac procedure, treatment, or event in recognition of their experience. A total of 7 staff members and 11 families were interviewed and particular stories were noted by staff. The case studies presented illustrated how nursing staff were able to recognize potential improvements to care and acknowledge the experiences of patients and families. Assumptions questioned as a result of the programme related to the complexity of the child's condition and gender. The death of a child and the acknowledgement of the child's life is also considered. Heart Beads allowed staff to reflect on the positive aspects of the care they provided.