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Background: A skin tear is a traumatic wound that occurs in up to one in five hospitalized patients. Nursing care includes application of a dressing to create a moist wound healing environment. Aim: To compare the effectiveness of two standard dressings (adhesive silicone foam vs. meshed silicone interface) to heal hospital‐acquired skin tear. Methods: An intention‐to‐treat pilot study was designed using a randomized, non‐inferiority trial in an Australian tertiary hospital setting. Consenting participants (n = 52) had acquired a skin tear within the previous 24 h and had agreed to a 3‐week follow‐up. Data were collected between 2014 and 2020. The primary outcome measure was wound healing at 21 days. Results: Baseline characteristics were similar in both arms. Per protocol, 86% of skin tears were fully healed at 3 weeks in the adhesive silicone foam group, compared to 59% in the meshed silicone interface group. Greater healing was observed across all skin tear categories in the adhesive silicone foam dressing group. In the intention‐to‐treat sample, healing was 69% and 42%, respectively. Conclusions: Results suggest the adhesive silicone foam dressing may be superior, as it produced clinically significant healing of skin tears at 3 weeks compared to the meshed silicone interface dressing. Accounting for potential loss to follow‐up, a sample of at least 103 participants per arm would be required to power a definitive study. Summary statement: What is already known about this topic? A skin tear is a traumatic wound that is commonly acquired during hospitalization that affects older adults in particular. In hospital settings, it may occur in up to one in five patients.A variety of skin tear dressings have been used in previous studies, with healing rates ranging from 34% to 97% at 21 days; however, evidence for the most effective dressing type is inconclusive.If treated inappropriately, or left untreated, minor skin tears can become chronic or complicated wounds, yet prevalence and treatment of hospital‐acquired injuries are under‐reported. What this paper adds? Based on our per‐protocol results, an adhesive silicone foam dressing may be superior, as it produced clinically significant healing of 86% of skin tears at 3 weeks compared to 59% with the meshed silicone interface dressing.Based on the methods and results from this pilot study, a future definitive trial would be feasible but would need to account for a relatively large loss to follow‐up rate. The implications of this paper: Using our intention‐to‐treat results, a future study would need a sample size of 103 per arm to be sufficiently powered, which may be impractical to achieve within a single hospital setting; thus, a multi‐site study would be advisable. [ABSTRACT FROM AUTHOR]

Introduction This paper, presented by the former nurse manager of cancer services at Royal North Shore Hospital, now working with Episoft, will discuss the pros and cons of nursing in a digital world. Objectives To look and discuss the benefits that digital health can bring to patient outcomes, as well as discussing what is sometimes compromised along the way and why? Description Digital health can improve communication and collaboration between health professionals which ultimately leads to better patient outcomes. Digital health is timely, contemporaneous and cannot be lost, erased or hidden. However, nurses are spending increasing amounts of time behind a computer screen, and some may argue that this would be better spent at the bedside. Patients are frequently interacting with nurses and health professionals who instead of fully engaging with the patient have their eyes on a computer screen. Digital health/technology is not going away. To be more meaningful the systems need to be simple to use, efficient and show their value to the clinician. The clinician needs to learn techniques to interact with patients using communication skills that need to be adapted to this new technological era. Results Digital technology enables faster access to patient information and there has been much work focused on the development of oncology software systems which are helping to provide safer more effective care. Systems can be tailored to individual workflows and can be cloud-based, reducing the need for costly hardware overheads. From booking to discharge with assessments, treatments, holistic planning, care, and management in one place. Conclusion Digital health systems can support the core functions of primary care, and the primary care giver. They need to be user-friendly and meaningful. There needs to be adequate and on-going training to ensure user competency and ensuring that the patient remains at the forefront of the care trajectory. [ABSTRACT FROM AUTHOR]

Background: Patient‐ and family‐centred care practices are a recommended part of contemporary care for the acutely ill hospitalized adult patients. However, how patient‐ and family‐centred care is enacted in an adult hospital setting is not well understood. Aims and Objectives: The aim of this study is to explore the perceptions of patients, family members and nurses regarding family participation and collaboration in patient care within an acute care setting, including the barriers and facilitators. Design This study used a mixed‐methods sequential design. Methods: Observer‐as‐participant observations and semistructured interviews were undertaken. Integration of the data was achieved through triangulation. Results: Triangulation revealed two metathemes. The first metatheme, 'continuum of family involvement', explained the central viewpoint of how family participation and collaboration in the care of acutely ill hospitalized adult patients was enacted. The second metatheme, 'nurses value family involvement', helped to explain and understand the barriers and facilitators to enacting family participation in the acute care setting. Conclusion: Promoting family participation in the acute care setting requires supporting multiple levels of engagement. Developing a relationship, clear communication and open sharing of information amongst patients, family members and nurses is critical to supporting family involvement. SUMMARY STATEMENT: What is already known about the topic? Health service policy emphasizes that patients and families should be treated with dignity and respect, be active partners in all aspects of care and contribute to the development and improvement of health care.In the acute care setting, both patients and family members express the desire for a larger role in health‐care decision making; yet how this is enacted in an adult hospital setting is not well understood.Research in other settings has demonstrated the clinical benefits of family involvement in care include decreased mortality, reduced hospital length of stay, improved adherence to treatment regimens and decreased readmission rates. What this paper adds? Supporting meaningful family participation in the acute care setting requires supporting multiple levels of engagement. When families felt empowered and participated in care, patients and family members believed it helped nurses to keep the patient safe and individualize care.The tripartite relationship amongst patients, family members and acute care nurses is essential in empowering family members to participate in the care of acutely ill hospitalized adult patients. However, nurses' values, beliefs and attitudes towards involving families in patient care are seen to be crucial to the possibility of embedding family participation in the acute care setting. The implications of this paper: Policies that incorporate the patient and families' voice and behavioural change interventions may lead to the normalization of patient‐ and family‐centred practices in the adult acute care hospital setting. [ABSTRACT FROM AUTHOR]

Haemodialysis (HD) is one form of kidney replacement treatment (KRT) for patients with kidney disease. HD removes fluid and toxins through diffusion and ultrafiltration. Isolated ultrafiltration (Iso Uf) may be performed to facilitate increased fluid removal, improve a patient's tolerability, and achieve the ultrafiltration goal (UFG). Iso Uf can be performed in association with, or in addition to, standard HD and requires no additional equipment. However, although this type of treatment has been evident for decades, there is minimal current evidence in relation to clinical practice, assessment criteria and process evaluation. Current practice trends are often based on clinical judgement, experience and patient assessment. Inconsistent practices have therefore been raised as an area for investigation in order to define appropriate standards of clinical care. The aim of this paper is to understand current practices in relation to Iso Uf, including assessment criteria, treatment interventions and evaluation strategies, and compare this with currently available literature in order to scope treatment considerations. [ABSTRACT FROM AUTHOR]

Aims: To investigate effectiveness of the nurse clinician as a Non‐Medical Surgical Assistant compared with the Medical Surgical Assistant. Background: Non‐Medical Surgical Assistants are clinicians who are not medical practitioners. The surgical assistant works directly with the primary surgeon intraoperatively. Design A pragmatic, retrospective, observational study on patients undergoing Laparoscopic Inguinal Hernia Repair or Primary Unilateral Total Hip Arthroplasty. Each patient received intraoperative care from a consultant surgeon and a Medical Surgical Assistant or Non‐Medical Surgical Assistant. All surgical assistants were registered with the Australian Health Practitioner Regulation Agency. Methods: Data were collected between 01/07/2014 and 30/06/2017. The effect that surgical assistant choice had on patient outcomes was estimated using regression statistical models. Six dependent variables, including length of stay, for clinical outcome assessment were specified. Results/Findings The groups were equivalent in age, gender, and American Society of Anaesthesiologists scores. There were more emergency procedures in the Medical Surgical Assistant group and more hip surgery in the Non‐Medical Surgical Assistant group. Patient outcome assessment showed no statistically significant differences for surgical assistant types. Conclusion: The nurse clinician in the role of Non‐Medical Surgical Assistant was shown to be effective with equivalent patient outcomes compared with the Medical Surgical Assistant. SUMMARY STATEMENT: What is already known about this topic? There is limited international research and no research conducted in Australia, investigating quality of care of the Non‐Medical Surgical Assistant.Existing research on Non‐Medical Surgical Assistants has been limited to a single specialty, which is often cardiac surgery.International research reports equal patient outcomes for the Non‐Medical Surgical Assistant using the comparator of the Medical Surgical Assistant; however, the Non‐Medical Surgical Assistant does not exclusively have a nursing‐based qualification in these studies. What this paper adds? Our study focuses on the two most common surgical specialties in Australia and the Non‐Medical Surgical Assistant with a nursing qualification of either a Registered Nurse or Nurse Practitioner.The results show that the choice of nursing or medical surgical assistant did not affect patient outcomes. The implications of this paper: In Australia, Registered Nurses and Nurse Practitioners can provide effective care in the role of surgical assistant compared with the Medical Surgical Assistant.While patient outcomes are equal, the Registered Nurse and Nurse Practitioner in Australia are not remunerated by the government similarly to the medical personnel undertaking the role of surgical assistant. This raises issues of inequity in the Australian health‐care system for patients accessing surgical care and making the role of surgical assistant unsustainable to non‐medical health‐care personnel.Findings are relevant to the Medicare Benefits Schedule Review Taskforce and access to the Medical Benefits Schedule for Non‐Medical Surgical Assistants. [ABSTRACT FROM AUTHOR]

Background: Patients with complex chronic conditions experience fragmentation of care, unnecessary hospitalization and reduced quality of life, with an increased incidence of poor health outcomes. Aim(s): The aim of this paper was to explore how nurse navigators manage client care. This was achieved through an examination of narratives provided by the nurse navigator that evaluated their scope of practice. Method(s): All nurse navigators employed by Queensland Health were invited to participate in a study evaluating the effectiveness of the service. Eighty‐four self‐reported vignettes were thematically analysed to understand the work from the nurses' perspectives. Results: Two themes emerged from the vignettes. Theme 1, the layers of complexity, is comprised of three sub‐themes: the complex patient, the complex system and patient outcomes. Theme 2, professional attributes, has two sub‐themes: person‐centred care and clinical excellence. Conclusion: Navigators innovatively integrate services and address the fragmented nature of the health system. They apply expert clinical and social skills, through consistent and robust communication, to meet the needs of those with multiple chronic conditions. Implications for nursing management: Results provide insight into the new role, illuminating the work they achieve, despite system complexities. [ABSTRACT FROM AUTHOR]

Aim: To describe for areas of improvement in the management of COPD and reduction in emergency department presentations in Queensland. Background: If current trends in the management of COPD do not change, the predicted 4.5 million Australians diagnosed with COPD by 2050 will place significant burdens on already over-utilised frontline ED services. Separately COPD is more costly per case than cardiovascular disease and is a more common presentation to Emergency Departments in any year than most types of cancer, road traffic accidents and heart disease. Study Design and Methods: This study used a qualitative thematic analysis methodology in which field convergent interviews were employed to generate data. Sixteen staff and nine patients across three major Southern Queensland Health acute care facilities participated in the study. The authors analysed interview data using qualitative thematic analysis. Results: This research has revealed several noteworthy concepts worthy of further exploration. Thematic analysis from both staff and patient interviews identified the following issues: 1. Nurse case management, 2. Integrated communication of patient assessment and history data, 3. Failure in COPD management, and 4. Knowledge utilisation among ED clinicians. Inherent among these key concepts is a primary goal of coordinated congruent COPD management that optimise a patient's functional status and quality of life, improving symptoms management, and avoiding recurrent exacerbations. Discussion: These insights into the experience of patients and hospital staff into the management of COPD provides valuable insight into current and desired practices that can help to minimise presentations to Emergency Departments. The findings of the research provide insights and future direction for improvements by addressing the inconsistency in disease management. The need for more accessible and consistent patient management and a more congruent centralised patient support framework was also identified. Conclusion: There is indication of support stemming from the voices of patients and hospital staff around the need for COPD case management to become the dominant method of care. Future research should consider the cost benefit and patient outcomes of the implementation of such a role and the avoidance of ED presentations. Implications for research, policy, and practice: The findings of this research imply a need to streamline the patient support and disease management discharged planning process by ensuring one health professional maintains ongoing education, support, and assessment to the patient. Future research needs to better ascertain the positive economic benefits to healthcare organisations by employing Case Managers for patients with COPD. What is already known about the topic? * Case management roles can be effective in reducing ED usage for adults with chronic illnesses. * The World Health Organization (WHO) has called for planned ongoing assessment, care and support coordinated by a proactive investment in real time solutions that address the increasing burden of this disease on the healthcare sector. * The WHO has endorsed targeted patient support strategies that coordinate care over time, addressing the physical and mental health needs of people with chronic illness. What this paper adds: * Findings from this research show that discharged planning support practices with Southern Queensland Healthcare Organisations require review and ongoing evaluation. * This may include, streamlining the patient support and disease management discharged planning; or designated case management or integration of systems to prevent ED presentations. * This research adds to the voices of patients and staff that confirm published research recommendations. [ABSTRACT FROM AUTHOR]

Objective This study aims to ascertain if differences exist in the perception of the professional practice environment and personal well-being of nurses across different geographical areas in Queensland. Design This paper was performed on a prospective, self-report cross-sectional on-line survey. Setting The study was conducted among the nurses employed in public and private health care settings: acute hospitals, community health and aged care in Queensland, Australia. Participants Participants of this study were 1608 registered and enrolled nurses and assistants in nursing, current members of the Queensland Nurses Union in 2013 and who provided a workplace postcode. One thousand eight of these participants worked in major cities, while 382 in rural locations and 238 in remote areas. Interventions None. Main outcome measures Scores of well-being as determined by the following scales: the Depression, Anxiety and Stress Scale, the Professional Quality of Life Scale version 5, the Connor-Davidson Resilience Scale and of the Professional Practice Environment using the Practice Environment Scale - Nursing Work Index Revised. Results Nurses employed in major cities perceived 'nursing foundations for quality care' more favourably than those from other settings. Remote area nurses had lower levels of secondary traumatic stress than nurses in major cities and rural areas. There was no difference between nurses across their geographical locations for stress, anxiety, depression, compassion satisfaction, burnout, resilience and the four other measures of the Practice Environment Scale. Conclusions The study findings provide new data suggesting that, with the exception of secondary traumatic stress, the personal well-being of nurses does not differ across geographical settings. Similarly, with the exception of the subscale of 'nursing foundations for quality care' there was no difference in perceptions of the professional practice environment. As secondary traumatic stress is associated with burnout, this finding needs to be investigated further. [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]

Introduction: Effective primary healthcare services have been identified by the World Health Organization as the most equitable approach to enhancing universal healthcare. Robust models of mentoring for registered nurses (RNs) transitioning to primary healthcare roles have yet to be described in the Australian context. A robust mentoring model can support RNs to fulfill their potential, bridging the gap between theory and practice. In 2015, the peak body for nurses in primary health care (PHC) began developing a transition to practice program, including embedded mentoring to support newly graduated and more experienced registered and enrolled nurses. This quality improvement study reports the experiences and perspectives of nurses participating as mentors in two separate offerings of the program delivered between 2019 and 2021. Method: A two-phase concurrent mixed methods evaluation utilized data from pre- and post online surveys and post program meetings. Quantitative items underwent descriptive analyses. Thematic analysis of free-text responses and comments was conducted independently by two researchers. Mentors voluntarily provided self-report data and were informed that data is routinely collected to support continuous quality improvement processes for all programs. An Information Sheet informed mentors of data usage, confidentiality, and options to withdraw without penalty from the program at any time. Results: Seventy-nine mentors were recruited to support two groups of nurses (N = 111). Mentor self-rated overall satisfaction with program participation was 86.67% (very or extremely satisfied). Mentors described being "witness to mentee growth," "having facilitated access to learning" and receiving "unexpected benefits" including personal and professional growth and enhanced enthusiasm for their role in PHC. Conclusion: The embedded mentoring reported in this article combined a focus on skills acquisition and professional identity with the provision of a range of resources and support activities. Sustainable mentoring programs will be an important mechanism for supporting the expanding roles required of nurses working in primary health. [ABSTRACT FROM AUTHOR]

An important way to advance the profession of nursing, to promote best practice and to improve the quality of nursing care, is for nurses to publish. A publication track record is necessary to gain competitive research funding, build knowledge, disseminate new insights and advance the profession. However, academics often experience obstacles in publishing ranging from a pervasive teaching culture, lack of confidence in writing, and lack of strategies to write more strategically. The benefits of writing retreats have been discussed within the nursing and other academic literature but the specifics about the method as well as the unplanned benefits have not been explored. More exploration and discussion is needed about factors assisting writers to complete papers and successfully publish. This paper discusses a novel intervention which aimed to seed the beginnings of a flourishing scholarly community at a regional Queensland University. The paper also presents qualitative and quantitative evaluation data. [ABSTRACT FROM AUTHOR]

Aim To develop and psychometrically test a survey instrument to identify the factors influencing the provision of end-of-life care by critical care nurses. Background Following a decision to withdraw life-sustaining treatment, critical care nurses remain with the patient and their family providing end-of-life care. Identification of factors influencing the provision of this care can give evidence to inform practice development and support nurses. Design A cross-sectional survey of critical care nurses. Method An online survey was developed, reviewed by an expert panel and pilot tested to obtain preliminary evidence of its reliability and validity. In May 2011, a convenience sample of critical care nurses ( n = 392, response rate 25%) completed the survey. The analytical approach to data obtained from the 58 items measured on a Likert scale included exploratory factor analysis and descriptive statistics. Results Exploratory factor analysis identified eight factors influencing the provision of end-of-life care: emotional support for nurses, palliative values, patient and family preferences, resources, organizational support, care planning, knowledge and preparedness. Internal consistency of each latent construct was deemed satisfactory. The results of descriptive statistics revealed a strong commitment to the inclusion of families in end-of-life care and the value of this care in the critical care setting. Conclusion This paper reports preliminary evidence of the psychometric properties of a new survey instrument. The findings may inform practice development opportunities to support critical care nurses in the provision of end-of-life care and improve the care that patients and their families receive. [ABSTRACT FROM AUTHOR]

Aim In this paper, we describe a trial protocol used to assess feasibility related to: study administration (recruitment, randomization, retention, compliance, eligibility criteria, suitability of protocol instructions and data collection questionnaires); resource and data management (suitability of site, time and budget allocation, management of personnel and data); intervention fidelity (treatment dose, violations); and effect size. Background Pressure injury can lead to increases in hospital length of stay and cost. The sacrum is identified as one of the most common anatomical pressure injury sites for hospitalized patients. Silicone foam border dressings have been proposed as one strategy to reduce pressure injury incidence; however, rigorous testing of benefit in a general medical-surgical population is required. Design Randomized controlled trial. Methods Eighty patients will be recruited after assessment of high risk of pressure injury in a large tertiary hospital in south-east Queensland, Australia. Eligible, consenting participants will be randomly allocated to either a control group (routine care) or an intervention group (routine care and a sacral prophylactic dressing). The primary outcomes comprise feasibility criteria as identified above. The secondary measure is the presence and severity of sacral pressure injury via blind assessment of digital photographs. Research ethics approval was received in October 2013. Discussion Prophylactic dressings applied to the sacrum may be an effective method for reducing pressure injury in high-risk general medical-surgical patients. However, more rigorous studies to confirm benefit are required. This pilot study will determine the feasibility and effect size to inform a larger randomized controlled trial. [ABSTRACT FROM AUTHOR]

Problem: Nurses are fundamental in presenting information to their patients to ensure understanding of information, and health directions enabling improved health outcomes. Limited research exists exploring how nurses assess patient's health literacy in Australia. Aim: To explore Australian nurses' perceptions of patients' health literacy and how nurses assess health literacy to provide patient education. Design: A qualitative study underpinned by phenomenology. Methods: Registered Nurses (N = 19) across five Queensland hospitals participated in semi‐structured interviews which explored nurses' assessment of patient's health literacy level and their practices of delivering education. The transcripts were analysed using an inductive process with interpretative analysis. Results: Four themes were identified: how we assess patient health literacy; challenges with health literacy assessment; consumer focused assessment; and building assessment strategies. Participants relied on cues from the patient to identify when information has not been understood. Participants felt that online training programs in the workplace would assist in education for assessment techniques; identification of patients with low health literacy; and how to best communicate with patients that have low health literacy. Conclusion: Formal health literacy assessments should be introduced to hospitals in Australia, but training is required to enable the nurse, the confidence and ability for health literacy assessment. Tailored education based on health literacy assessment would enhance the patient's understanding and improve discharge planning, which may reduce health service costs and readmissions. Reporting method: The Consolidated criteria for reporting qualitative research (COREQ) guidelines for qualitative research were followed. Patient or public contribution: Registered Nurses (N = 19) participated in qualitative interviews, providing data for analysis. Relevance to clinical practice: This study shows that nurses are already conducting informal assessments, simply by using observation and looking for cues. More education for nurses about health literacy and how to tailor their discussions with patients will improve communication. [ABSTRACT FROM AUTHOR]

Aim: To determine the reporting accuracy of pressure injury categorisation by bedside clinicians, compared with nurse experts. Background: Pressure injuries are an enduring complication of hospitalisation. The categorisation of pressure injury affects treatment and management decision‐making and use of resources, and severe hospital‐acquired pressure injury incidence is used to benchmark quality of care. However, it is unclear how accurately pressure injuries are categorised by clinicians in practice. Design: Secondary analysis of hospital pressure injury incident and validation data. Methods: All pressure injuries reported in adults between 2016 and 2019 that were subsequently validated by nurse experts were analysed. Absolute agreement is reported using percentages, with inter‐rater agreement reported using Kappa measure of agreement. The GRRAS reporting guideline was followed. Results: Of 6186 pressure injuries that were analysed, the category was reported correctly in 67.3% (n = 4163), with an overall moderate level of inter‐rater agreement by category (Κ =.567, p <.001). Of those found to be non‐pressure injuries when validated (18.3%, n = 1129), most were reported originally as stage II (41.2%, n = 465) or stage I (30.5%, n = 344), and 13.4% (n = 151) were categorised initially as unstageable. The majority reported initially as stage I, stage II, suspected deep tissue injury or mucosal pressure injury were validated, whereas half of those reported initially as stage III or IV were validated and less than a third of those reported initially as unstageable pressure injuries were validated. Conclusions: This study provides important insight into the accuracy of pressure injury categorisation. Whilst moderate agreement of categorisation was found between reporting clinicians and nurse experts, pressure injury differential diagnosis and categorisation of severe injuries were inadequate. Relevance to Clinical Practice: These results may be used for benchmarking and provide a focal point for future education and practice improvement efforts. Patient or Public Contribution: Neither patients nor the public were directly involved in the project. [ABSTRACT FROM AUTHOR]

To meet changing health service demands, it is critical that speech-language pathologists (SLPs) are working to full scope, considering extended scope models when appropriate, and incorporating delegation models. One such extended scope role for SLPs is medication administration in specialist clinic settings. This paper outlines the process undertaken by SLPs in a particular service to obtain rights for the administration of Co- Phenylcaine Forte nasal spray during nasendoscopy and examines the outcomes of its use within a prospective cohort study. Data from the first 100 patients involved in Co-Phenylcaine Forte nasal spray administration within a single Queensland health facility was collected in relation to outcomes and clinician confidence. The results of the trial revealed administration was performed with 95% of attending patients, clinician confidence with administering was high, and there was only one mild adverse event. This pilot trial suggests independent SLP administration of CoPhenylcaine Forte nasal spray during nasendoscopy is safe when used in a supported environment, and following appropriate training. [ABSTRACT FROM AUTHOR]

Background: Patients from culturally and linguistically diverse (CALD) backgrounds often have unmet healthcare coordination needs. We aimed to evaluate the acceptability, utilisation and perceived benefits of the Mater CALD Health Coordinator Service (M-CHooSe), a pilot, nurse-led, general practice co-located, healthcare coordination service for patients from CALD backgrounds. Methods: M-CHooSe began in March 2020 at five Brisbane (Queensland) sites. Process and service user data were collected over 12 months at one site. A survey evaluated primary healthcare professionals' perceived benefits of the service. Another survey of M-CHooSe nurses examined indicators of service complexity. Results: In total, 206 individuals accessed M-CHooSe over the 12-month period. Commonly delivered services included health service advocacy, chart reviews and health system navigation, including addressing social determinants. M-CHooSe nurses reported frequently performing tasks such as following up with external health services and performing health and social care system coordination. M-CHooSe benefits reported by primary healthcare professionals included better patient access to external health services and improved patient understanding of their conditions and treatments. Conclusion: Patients were accepting of referrals to M-CHooSE. Primary healthcare professionals also reported a variety of benefits to themselves and their patients because of M-CHooSe. M-ChooSe highlights the potential of a healthcare coordination service for multicultural patients to improve healthcare equity, accessibility, and system efficiency. This project demonstrates the potential value of coordination services to increase patient access and uptake of existing health and social care services for modern Australian communities, thus improving the efficiency and effectiveness of our health system. Further investigations, including user experience, opinions and cost analyses, will be required to confirm the promising benefits of embedding M-CHooSe into usual care. People with multicultural or refugee backgrounds are more likely to have poorer long-term health outcomes compared to natively born people, and experience barriers accessing health care. We piloted a multicultural healthcare coordinator service and demonstrated that it was acceptable to patients and primary healthcare practitioners, well-utilised and demonstrated good outcomes. The service has the potential to reduce healthcare inequities if implemented into ongoing primary care services. [ABSTRACT FROM AUTHOR]

Clinical facilitation is critical to successful student clinical experience. The research reported in this paper used an interpretive case study to explore perspectives of clinical facilitators on what constitutes best practice in clinical facilitation of undergraduate nursing students. Eleven clinical facilitators from South East Queensland, Australia, participated in focus groups, interviews and a concept mapping exercise to gather their perspectives on best practice. The data gathered information regarding their prior and current experiences as registered nurses and facilitators, considering reasons they became clinical facilitators, their educational background and self-perceived adequacy of their knowledge for clinical facilitation. Analysis was through constant comparison. Findings of the study provided in-depth insight into the role of clinical facilitators, with best practice conceptualised via three main themes; ‘assessing’, ‘learning to facilitate’ and ‘facilitating effectively’. While they felt there was some autonomy in the role, the clinical facilitators sought a closer liaison with academic staff and feedback about their performance, in particular their assessment of the students. Key strategies identified for improving best practice included educational support for the clinical facilitators, networking, and mentoring from more experienced clinical facilitators. When implemented, these strategies will help develop the clinical facilitators' skills and ensure quality clinical experiences for undergraduate nursing students. [ABSTRACT FROM AUTHOR]

Aim(s): To ascertain nurses' perceptions about, and suggestions for, management solutions to workplace violence perpetrated by patients. Background: Violence towards nurses from patients in the workplace is high in Australia. There is a need for good management responses, and experienced nurses can provide logistical suggestions about effective strategies. Method(s): This study uses an exploratory qualitative design. Focus group interviews were undertaken with 23 nurses working in a regional public hospital in Queensland, Australia. The COREQ research reporting checklist was followed, and the qualitative data were transcribed and thematically analysed manually and by NVivo. Results: Policy implementation, training, staff movement, seclusion, debriefing and a full reporting cycle were identified as central themes. Workplace violence management happens before, during and after a violent event. Conclusion(s): Weak processes undermine management; staff training on de‐escalation is needed. Affected staff need freedom to move from the ward. Better medical orders should be in place before an event. A full debriefing and feedback cycle are required, along with easier reporting processes. Implications for Nursing Management: Nursing management can reduce violence by ensuring better institutional support, consistent follow‐up and complete feedback procedures. Legal support, follow‐up mechanisms and staff training in de‐escalation are key points. [ABSTRACT FROM AUTHOR]

Residential aged care facilities (RACFs) face severe challenges in the provision of high-quality end of life care. A pilot of a nurse-led end-of-life palliative care consultative service (CiMaS) supporting RACFs was conducted in three RACFs in the West Moreton Region of Queensland, Australia, from May 2018. We conducted a mixed method evaluation comprising: a chart audit of deaths in the 12 months before and after the intervention; focus groups with RACF staff; and interviews with facility directors, primary family members and GPs. Quantitative and Qualitative data were assessed separately with statistical and thematic analyses respectively. The RACFs cared for 277 residents. There were 24 pre-intervention deaths and 44 in the intervention period (28 (64%) referred to CiMaS). There was widespread support for the service. Families felt supported and knowledgeable about what was happening. Care plans were almost always recorded in health records. Patients' symptoms appeared to be better recognised and managed. Staff and Facility managers felt more support than previously, with more responsive and reliable out of hours support. There were significant care improvements in patients not referred to CiMaS, suggesting a learning effect. GPs observed improvements in nursing staff confidence and support to families. Transfers to hospitals fell by two-thirds for both referred and non-referred patients compared with the year before implementation. The program was both efficient and effective. [ABSTRACT FROM AUTHOR]

Background: A significant barrier to the access of safe abortion is the lack of trained abortion providers. Recent studies show that with appropriate education, nurses and midwives can provide abortions as safely as medical practitioners. Aims: To examine the attitudes and practices of registered midwives (RMs) and sexual health nurses (SHNs) in Queensland toward abortion. Materials and Methods: A cross‐sectional mixed‐methods questionnaire was distributed to RMs and SHNs from the Queensland Nursing and Midwifery Union. Data were described and analysed both quantitatively and qualitatively. Results: There was a 20% response rate (n = 624) to the survey from the overall study population. There were 53.5% who reported they would support the provision of abortion in any situation at all; 7.4% held views based on religion or conscience that would make them completely opposed to abortion. There were 92.9% who felt that education surrounding abortion should be part of the core curriculum for midwifery and/or nursing students in Australia. The qualitative responses demonstrated a variety of views and suggestions regarding the practice of abortion. Conclusions: There was a wide variation in views toward induced abortion from RMs and SHNs in Queensland. While a proportion of respondents opposed abortion in most circumstances, a significant group was in support of abortion in any situation and felt involvement in initiating and/or performing abortion would be within the scope of RMs and SHNs. [ABSTRACT FROM AUTHOR]

Aim: To explore the perceptions and experiences of nurses in communicating the care and caring in the intensive care unit (ICU). Design: A focused ethnography. Methods: This study was conducted in an Australian metropolitan hospital, in which data were gathered from multiple sources: participant observations, document reviews, interviews, and participant's additional written information ‐ over six months (April‐September, 2014). The data were analysed thematically. Findings: This study addressed inclusively communicating care and caring to patients, families, nurses and other health professionals in ICU. The findings identified main themes concerning the changing patterns of communicating the care and caring in ICU, various patterns of communication used, enablers and barriers of communicating care and caring, and significant issues in communicating care and caring in ICU. Documentation of patients' psychological and emotional needs, and nurses' caring behaviours are crucial. These findings need further consideration from all stakeholders. [ABSTRACT FROM AUTHOR]

Background: Nurses have limited time outside of work for continuing professional development. Consequently, strategies need to be explored to enable them to better maintain their competence. This article describes recent research investigating if nursing behaviours in the use of mobile technologies could be leveraged to better facilitate mobile learning. It addresses a gap in the existing literature around how nurses resource their own professional development and learning in the absence of appropriate learning resources in the workplace. Methods: The research employed a classic grounded theory methodology which was conducted with 27 registered nurses from Public and Private Hospitals in Queensland and external postgraduate nursing students from Victoria, South Australia and the Northern Territory enrolled at the University of Southern Queensland. Results: The Theory of Economising Learning describes how nurses maintain competence with limited resources. Unfavourable staffing levels and a fast-paced workplace mean that nurses rarely prioritise their professional learning while at work. Instead, it requires the nurse to contribute personal resources including time and money. Though the research revealed nurses were unconcerned about using mobile technologies, they were concerned about maintaining competence with limited resources. To counter this, nurses economised their learning by balancing personal resources against their motivation to maintain competence. The process of economising learning begins and ends with the development of the nurse's personal curriculum in response to what they identify as being the most significant knowledge deficits at work that jeopardise their competence. A learning opportunity that addresses the knowledge deficit is sought. Nurses balance the opportunity to address the deficit against the cost of personal resources, to decide if they will engage with the opportunity and update their personal curriculum accordingly. Conclusions: It is suggested that workplaces need to create reasonable expectations within nurses to address knowledge deficits and provide the resources, including time, to allow them to do so without personal cost. It is also necessary for workplaces to moderate the flow of learning opportunities so as not to overwhelm and demotivate the nurses. Currently, nurses use several strategies to optimise their learning using mobile technologies which could be leveraged in the workplace. [ABSTRACT FROM AUTHOR]

Care staff in residential aged care facilities (nursing homes) in Australia are obligated, under the Australian National Framework for Action on Dementia 2015–2019, to support residents to exercise choice and make decisions. Research indicates, however, that care staff are often given little guidance regarding which residents' decisions should be supported or how to make decisions on their behalf. This lack of guidance can result in a denial of residents' rights and inconsistent treatment by staff, placing residents' wellbeing at risk. Through providing an analysis of the responses of staff at RACFs in Victoria and Queensland to two case scenarios, this study seeks to provide some understanding of the difficulties staff face in supporting residents' self-determination and their own need for greater organisational support. [ABSTRACT FROM AUTHOR]

Objective. People detained in police custody are a vulnerable population with complex health needs, sometimes requiring emergency care. This study evaluated the effect of a 24/7 nursing presence in a police watch house on police presentations to the emergency department (ED). Methods. This was a retrospective observational study conducted in a regionalEDin Queensland. Equal time periods of 66 days before (T1), during (T2) and after (T3) the pilot service was trialled in 2013 were compared to determine changes in patient and service delivery outcomes. The time to see a doctor in the ED, ED length of stay, hospital admission rate, number of transfers from the watch house to the ED and associated costs were measured. The nature of health care delivered by nurses to detainees in the watch house during the pilot was also examined. Results. Fewer detainees were transferred from the police watch house to the ED during the pilot period (T1, n =40; T2, n = 29; T3, n = 34). Cost reductions associated with reduced police and ambulance attendance, as well as hospitalisations, outweighed the watch house nursing costs, with cost savings estimated at AUD7800 per week (60% benefiting police; 40% benefiting the health service). The most common health problems addressed during the 1313 healthcare delivery episodes provided to 351 detainees in the watch house during the pilot related to substance misuse, chronic disease and mental health problems. Conclusion. Fewer transfers from the police watch house to the ED were noted when there was a 24/7 nursing presence in the watch house. This model appears to be economically efficient, but further research is required. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine nurses' perceptions of physical and verbal violence perpetrated by patients and visitors and to investigate themes surrounding gender and the incidence of violence. Background: The prevalence of violence towards nurses is a concern for nurses and hospital administrators. However, nurses who work in acute care and mental healthcare settings are particularly at high risk. This study examines the occurrence, type of violence and gender issues in a regional public hospital of Queensland Australia. Design: An exploratory, qualitative design. Methods: Focus group interviews with 23 nurses from Emergency Department (ED), Intensive Care Unit (ICU) and Psychiatry Department (PD) working in Queensland regional public hospital, Australia. Qualitative data were transcribed and thematically analysed manually and by NVivo. COREQ research reporting checklist followed. Results: Participants reported frequent incidents of verbal and physical violence on a daily basis. Severe incidence included punching, kicking, biting and scratching, as well as threats of using weapons, such as knives. Patients were more likely to exhibit physical violence, especially towards male nurses, while hospital visitors including patient's family were more likely to exhibit verbal violence. Allocating male nurses in volatile areas and to care for violent patients raises concerns that the male nurses may be seen by their patients as "bodyguards" and not as a professional nurse. Conclusion: Findings indicate that staff believe that violence is increasing, feel the burden to accept that violence as part of the job and that the bureaucratic processes of the organisation make it difficult to address violence or get support. Organisations need to be vigilant in ensuring assistance is accessible and simplified. Relevant to clinical practice: This study contributes new knowledge to the discussion concerning of gender issues. Identifying gender issues could assist in developing the necessary interventions to reduce workplace violence. [ABSTRACT FROM AUTHOR]

Background: Early warning systems (EWS) are most effective when clinicians monitor patients' vital signs and comply with the recommended escalation of care protocols once deterioration is recognised.Objectives: To explore sociocultural factors influencing acute care clinicians' compliance with an early warning system commonly used in Queensland public hospitals in Australia.Methods: This interpretative qualitative study utilised inductive thematic analysis to analyse data collected from semi-structured interviews conducted with 30 acute care clinicians from Queensland, Australia.Results: This study identified that individuals and teams approached compliance with EWS in the context of 1) the use of EWS for patient monitoring; and 2) the use of EWS for the escalation of patient care. Individual and team compliance with monitoring and escalation processes is facilitated by intra and inter-professional factors such as acceptance and support, clear instruction, inter-disciplinary collaboration and good communication. Noncompliance with EWS can be attributed to intra and inter-professional hierarchy and poor communication.Conclusions: The overarching organisational context including the hospital's embedded quality improvement and administrative protocols (training, resources and staffing) impact hospital-wide culture and influence clinicians' and teams' compliance or non-compliance with early warning system's monitoring and escalation processes. Successful adoption of EWS relies on effective and meaningful interactions among multidisciplinary staff. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In Australia and internationally, co‐responder models are becoming an increasingly common intervention to respond to police callouts where there is an assumed mental health‐related component or crisis. This type of model involves a collaborative approach where trained police officers team with mental health clinicians to provide specialized responses in order to improve outcomes for persons with mental illness. However, there is limited understanding as to major elements required for implementation of the model. This study aims to identify the essential elements and challenges in implementation of the Mental Health Co‐Responder Project in Cairns, Australia, where the team consists of a mental health nurse with demonstrated competencies in crisis intervention and a specially trained police officer. In 2016, 39 participants completed semi‐structured interviews regarding knowledge and experience of the Cairns co‐responder model. The participants represented first responders and community‐based service providers who work with and support persons living with mental illness. Using a thematic analysis approach, key elements identified as essential to successful project implementation were as follows: co‐responder team characteristics,senior and project executive level support,collaborative project governance, andco‐location of the team within a mental health setting. The main perceived challenges to project implementation included the following: initial concerns regarding client confidentiality, lack of an evaluation plan, and adequate project resourcing. Governance through a vigorous joint agency operation committee and adequate resourcing is imperative to the sustainability of this model. [ABSTRACT FROM AUTHOR]

Background: Some patients do not receive adequate pain and symptom relief at the end of life, causing distress to patients, families and healthcare professionals. It is unclear whether undertreatment of symptoms occurs, in part, because of nurses' concerns about legal and/or disciplinary repercussions if the patient dies after medication is administered. Aim: The aim was to explore nurses' experiences and knowledge of the law relating to the provision of end-of-life pain and symptom relief. Design: Semi-structured interviews with nurses were assessed using a six-stage hybrid thematic analysis technique. Setting/participants: Four face-to-face and 21 telephone interviews were conducted with nurses who routinely prescribed and/or administered pain and symptom relief to patients approaching the end of their lives in Queensland and New South Wales, Australia. Results: While many nurses had no personal experiences with legal or professional repercussions after a patient had died, the fear of hastening death and being held accountable was frequently discussed and regarded as relevant to the provision of inadequate pain and symptom relief. Concerns included potential civil or criminal liability and losing one's job, registration or reputation. Two-thirds of participants believed that pain relief was sometimes withheld because of these legal concerns. Less than half of the interviewed nurses demonstrated knowledge of the doctrine of double effect, the legal protection for health professionals who provide end-of-life pain and symptom relief. Conclusion: Education is urgently required to strengthen nurses' knowledge of the legal protections supporting the provision of appropriate palliative medication, thereby improving their clinical practice with end-of-life patients. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims and objectives: To explore nurse and nursing assistant reflections on the care of older patients with cognitive impairment who have experienced a fall. Background: While there are evidence‐based clinical guidelines for the prevention and management of falls and for the care of older people with cognitive impairment, the falls rates for older people with cognitive impairment are three times as high as those without. Design: Critical incident technique. Methods: Eleven registered and two enrolled nurses and four assistants in nursing working in one subacute and two acute wards within two hospitals of a tertiary level health service in south‐east Queensland. Individual semistructured interviews focused on two past events when a patient with cognitive impairment had fallen in hospital: one when there was minimal harm and the second when there was significant harm. Thematic analysis was undertaken. The COREQ checklist was followed. Results: Three themes emerged from 23 reflective accounts of fall events: "direct observation is confounded by multiple observers" and "knowing the person has cognitive impairment is not enough," and "want to rely on the guideline but unsure how to enact it." While participants were aware of the falls prevention policy and techniques available to prevent falls, the implementation of these was challenging due to the complexity of care required by the older person with cognitive impairment. Conclusions: Falls prevention for older people with cognitive impairment is complex and belies the simple application of policy. Relevance to clinical practice: To reduce falls, nurses can involve the family to support "knowing the patient" to enable prediction of impulsive actions; shift the focus of in‐service from lectures to specific case presentations, with collaborative analysis on person‐focused strategies to prevent falls in older people with cognitive impairment; and reconsider the sitter role from simple observer to assistant, focused on ambulation and supporting independence in activities of daily living. [ABSTRACT FROM AUTHOR]

Aims: To explore nurses' perceptions of factors affecting workloads and their impact on patient care. Background: Fiscal restraints and unpredictable patient illness trajectories challenge the provision of care. Cost containment affects the number of staff employed and the skill‐mix for care provision. While organisations may acknowledge explicit rationing of care, implicit rationing takes place at the point of service as nurses are forced to make decisions about what care they can provide. Method: A self‐report cross sectional study was conducted using an on‐line survey with 2,397 nurses in Queensland, Australia. Results: Twenty to forty per cent reported being unable to provide care in the time available; having insufficient staff; and an inadequate skill‐mix. The respondents reported workload and skill‐mix issues leading to implicit care rationing. Over 60% believed that the processes to address workload issues were inadequate. Conclusions: Institutional influences on staffing levels and skill‐mix are resulting in implicit care rationing. Implications for Nurse Managers: Adequate staffing should be based on patient acuity and the skill‐mix required for safe care. Managers should be more assertive about adequate clinical workloads, involve staff in decision‐making, and adopt a systematic planning approach. Failure to do so results in implicit care rationing impacting on patient safety. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate whether awareness of manual respiratory rate monitoring affects respiratory rate in adults, and whether count duration influences respiratory rate estimates. Background: Nursing textbooks typically suggest that the patient should ideally be unaware of respiratory rate observations; however, there is little published evidence of the effect of awareness on respiratory rate, and none specific to manual measurement. In addition, recommendations about the length of the respiratory rate count vary from text to text, and the relevant empirical evidence is scant, inconsistent and subject to substantial methodological limitations. Design: Experimental study with awareness of respiration monitoring (aware, unaware; randomised between-subjects) and count duration (60 s, 30 s, 15 s; within-subjects) as the independent variables. Respiratory rate (breaths/minute) was the dependent variable. Methods: Eighty-two adult volunteers were randomly assigned to aware and unaware conditions. In the baseline block, no live monitoring occurred. In the subsequent experimental block, the researcher informed aware participants that their respiratory rate would be counted, and did so. Respirations were captured throughout via video recording, and counted by blind raters viewing 60-, 30- and 15-s extracts. The data were collected in 2015. Results: There was no baseline difference between the groups. During the experimental block, the respiratory rates of participants in the aware condition were an average of 2.13 breaths/minute lower compared to unaware participants. Reducing the count duration from 1 min to 15 s caused respiratory rate to be underestimated by an average of 2.19 breaths/minute (and 0.95 breaths/minute for 30-s counts). The awareness effect did not depend on count duration. Conclusions: Awareness of monitoring appears to reduce respiratory rate, and shorter monitoring durations yield systematically lower respiratory rate estimates. Relevance to clinical practice: When interpreting and acting upon respiratory rate data, clinicians should consider the potential influence of these factors, including cumulative effects. [ABSTRACT FROM AUTHOR]

Abstract: Background: The validity of instruments is crucial in ensuring that data collected are sound and that these data represent what the instrument claims to measure. When an instrument is revised or used in a different population, it is useful to re‐examine its construct validity. Aim: To test the psychometrics properties of an instrument—the revised Families’ Importance In Nursing Care—Nurses’ Attitudes, designed to measure nurse’ attitudes towards involving family in nursing care in an adult acute care setting. Design and methodology: A cross‐sectional survey design was used in April–May 2016 with a sample of Enrolled and Registered Nurses (N = 212) to test the factor structure of the revised Families’ Importance In Nursing‐Nurses’ Attitudes instrument. The instrument had 26 items with a five‐point Likert response scale. Principle components analysis and exploratory factor analysis were performed with oblique rotations to assess the internal structure of the instrument. Setting: A regional referral hospital in Queensland, Australia. Results: Using Principal Components Analysis and Principal Axis Factoring, we obtained the same factor structure to that originally identified for the instrument. Our results suggested the removal of six items to refine the instrument and achieve simple structure. Conclusion: The removal of several items, relabeling of factors and residual cross‐loading issues suggest that further revisions to the instrument are needed. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine the quality and safety of nurse practitioner services of two newly implemented nurse practitioner models of care at a correctional facility. Background Nurse practitioners could help to meet the physical and mental health needs of Australia's growing prison population; however, the nurse practitioner role has not previously been evaluated in this context. Design A quality assurance study conducted in an Australian prison where a primary health nurse practitioner and a mental health nurse practitioner were incorporated into an existing primary healthcare service. The study was guided by Donabedian's structure, processes and outcomes framework. Methods Routinely collected information included surveys of staff attitudes to the implementation of the nurse practitioner models ( n = 21 staff), consultation records describing clinical processes and time use ( n = 289 consultations), and a patient satisfaction survey ( n = 29 patients). Data were analysed descriptively and compared to external benchmarks where available. Results Over the two-month period, the nurse practitioners provided 289 consultations to 208 prisoners. The presenting problems treated indicated that most referrals were appropriate. A significant proportion of consultations involved medication review and management. Both nurse practitioners spent more than half of their time on individual patient-related care. Overall, multidisciplinary team staff agreed that the nurse practitioner services were necessary, safe, met patient need and reduced treatment delays. Conclusions Findings suggest that the implementation of nurse practitioners into Australian correctional facilities is acceptable and feasible and has the potential to improve prisoners' access to health services. Structural factors (e.g., room availability and limited access to prisoners) may have reduced the efficiency of the nurse practitioners' clinical processes and service implementation. Relevance to clinical practice Results suggest that nurse practitioner models can be successfully integrated into a prison setting and could provide a nursing career pathway. [ABSTRACT FROM AUTHOR]

Background: Neonatology has made significant advances in the last 30 years. Despite the advances in treatments, not all neonates survive and a palliative care model is required within the neonatal context. Previous research has focused on the barriers of palliative care provision. A holistic approach to enhancing palliative care provision should include identifying both facilitators and barriers. A strengths-based approach would allow barriers to be addressed while also enhancing facilitators. The current study qualitatively explored perceptions of neonatal nurses about facilitators and barriers to delivery of palliative care and also the impact of the regional location of the unit. Methods: The study was conducted at the Townsville Hospital, which is the only regional tertiary neonatal unit in Australia. Semi-structured interviews were conducted with a purposive sample of eight neonatal nurses. Thematic analysis of the data was conducted within a phenomenological framework. Results: Six themes emerged regarding family support and staff factors that were perceived to support the provision of palliative care of a high quality. Staff factors included leadership, clinical knowledge, and morals, values, and beliefs. Family support factors included emotional support, communication, and practices within the unit. Five themes emerged from the data that were perceived to be barriers to providing quality palliative care. Staff perceived education, lack of privacy, isolation, staff characteristics and systemic (policy, and procedure) factors to impact upon palliative care provision. The regional location of the unit also presented unique facilitators and barriers to care. Conclusions: This study identified and explored facilitators and barriers in the delivery of quality palliative care for neonates in a regional tertiary setting. Themes identified suggested that a strengths-approach, which engages and amplifies facilitating factors while identified barriers are addressed or minimized, would be successful in supporting quality palliative care provision in the neonatal care setting. Study findings will be used to inform clinical education and practice. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to examine the decision-making of nursing students during team based simulations on patient deterioration to determine the sources of information, the types of decisions made and the influences underpinning their decisions. Background Missed, misinterpreted or mismanaged physiological signs of deterioration in hospitalized patients lead to costly serious adverse events. Not surprisingly, an increased focus on clinical education and graduate nurse work readiness has resulted. Design A descriptive exploratory design. Methods Clinical simulation laboratories in three Australian universities were used to run team based simulations with a patient actor. A convenience sample of 97 final-year nursing students completed simulations, with three students forming a team. Four teams from each university were randomly selected for detailed analysis. Cued recall during video review of team based simulation exercises to elicit descriptions of individual and team based decision-making and reflections on performance were audio-recorded post simulation (2012) and transcribed. Results Students recalled 11 types of decisions, including: information seeking; patient assessment; diagnostic; intervention/treatment; evaluation; escalation; prediction; planning; collaboration; communication and reflective. Patient distress, uncertainty and a lack of knowledge were frequently recalled influences on decisions. Conclusions Incomplete information, premature diagnosis and a failure to consider alternatives when caring for patients is likely to lead to poor quality decisions. All health professionals have a responsibility in recognizing and responding to clinical deterioration within their scope of practice. A typology of nursing students' decision-making in teams, in this context, highlights the importance of individual knowledge, leadership and communication. [ABSTRACT FROM AUTHOR]

Purpose To describe and understand activities patients and nurses undertake to enact patient participation in nursing care. Design This observational study was conducted on two medical units at a public hospital in Australia. Twenty-eight nurse-patient dyads were observed for at least 4 hr. Data were collected from November 2013 to February 2014. Methods Field notes were collected and were analyzed both inductively and deductively. Findings Nurse-patient interactions promoted patient participation through dialogue and knowledge sharing. Less evident was patient involvement in planning or self-care. Nurses exerted control over patient care, which influenced the extent of patient participation. Conclusions Patient participation appears to be difficult to enact. Nurses' controlling approach, influenced by organizational issues, was in conflict with a patient-centered approach to care. Nurse-patient communication is one aspect of patient-centered care enacted more frequently. Clinical Relevance Nurses may benefit from strategies at the individual and organizational level to enhance their patient-centered practices. Fostering nurses' communication may enhance patient-centered practices in hospitals. [ABSTRACT FROM AUTHOR]

Aims and objectives To determine consensus across acute care specialty areas on core physical assessment skills necessary for early recognition of changes in patient status in general wards. Background Current approaches to physical assessment are inconsistent and have not evolved to meet increased patient and system demands. New models of nursing assessment are needed in general wards that ensure a proactive and patient safety approach. Design A modified Delphi study. Methods Focus group interviews with 150 acute care registered nurses at a large tertiary referral hospital generated a framework of core skills that were developed into a web-based survey. We then sought consensus with a panel of 35 senior acute care registered nurses following a classical Delphi approach over three rounds. Consensus was predefined as at least 80% agreement for each skill across specialty areas. Results Content analysis of focus group transcripts identified 40 discrete core physical assessment skills. In the Delphi rounds, 16 of these were consensus validated as core skills and were conceptually aligned with the primary survey: (Airway) Assess airway patency; (Breathing) Measure respiratory rate, Evaluate work of breathing, Measure oxygen saturation; (Circulation) Palpate pulse rate and rhythm, Measure blood pressure by auscultation, Assess urine output; (Disability) Assess level of consciousness, Evaluate speech, Assess for pain; (Exposure) Measure body temperature, Inspect skin integrity, Inspect and palpate skin for signs of pressure injury, Observe any wounds, dressings, drains and invasive lines, Observe ability to transfer and mobilise, Assess bowel movements. Conclusions Among a large and diverse group of experienced acute care registered nurses consensus was achieved on a structured core physical assessment to detect early changes in patient status. Relevance to clinical practice Although further research is needed to refine the model, clinical application should promote systematic assessment and clinical reasoning at the bedside. [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]

Aim To test the psychometric properties of the COMHON (Conscious level, Mobility, Haemodynamics, Oxygenation, Nutrition) Index. Background Pressure injury risk assessment is a crucial aspect in determining the relative risk of patients and the need for preventative intervention. In the intensive care setting there are few risk assessment scales that have been developed specifically for critically ill patients. Design Instrument development. Methods A convenience sample of 26 intensive care patients was used. Data were collected in December 2012. Five intensive care nurses scored each patient with all four scales. Intraclass correlation coefficients and standard errors of measurement were used to assess inter-rater reliability and agreement of the sum, risk category and item scores. Convergent validity of the COMHON Index was investigated by examining correlations between the sum scores and similar constructs of the scales. Results Inter-rater reliability of the COMHON Index was higher than the other scales and strong correlations were found between it and the Braden and Norton scales but not the Waterlow score. Two items common to all scales (mobility; neurological status) demonstrated significant correlations between the COMHON, Braden and Norton scales but not the Waterlow score. One item (nutrition) was significantly correlated between the COMHON and Braden scales. Conclusion Inter-rater reliability and agreement of the COMHON Index were the highest of the four scales, with the Norton and Braden performing similarly and the Waterlow score the least well. The strong and significant associations between the Braden, COMHON and Norton scales suggest they are measuring similar constructs. [ABSTRACT FROM AUTHOR]

Aims To assess the medication knowledge of emergency department nurses and determine the factors affecting their nurse-initiated medication practices. Background Nurse-initiated medications is a vital practice for all nurses in emergency departments which improves pain assessment, provides safe pain management and reduces time-to-analgesia and other meaningful treatments. Design Mixed methods. Between September 2014-January 2015, data were collected by questionnaire assessing medication knowledge and face-to-face interviews determining factors affecting practice. Results Nurse-initiated medications frequency of the Registered Nurses ranged from 0-36 times per week dependent on employed hours and emergency department area worked. Medication knowledge was consistent among nurses, but there was an overall deficit in nurses' knowledge of mechanism of action. Four major themes were identified from the 24 interviews: patient-centred care, caution and safety as principles of practice; continuing support and education; improvement of practice over time. All nurses regard the practice positively and to be extremely beneficial to patients. Although apprehensive at the start of their nurse-initiated medications practice, confidence improved with exposure and experience. Nurses sought additional information from colleagues and the available evidence-based resources. Conclusion Medication knowledge is not the sole determinant of nurse-initiated medications practice. The practice is motivated by multiple factors such as patients' needs, safety and nurses' confidence. [ABSTRACT FROM AUTHOR]

Aim. To systematically evaluate the impact of several design features on chart-users' detection of patient deterioration on observation charts with early-warning scoring-systems. Background. Research has shown that observation chart design affects the speed and accuracy with which abnormal observations are detected. However, little is known about the contribution of individual design features to these effects. Design. A 2929292 mixed factorial design, with data-recording format (drawn dots vs. written numbers), scoring-system integration (integrated colour-based system vs. non-integrated tabular system) and scoring-row placement (grouped vs. separate) varied within-participants and scores (present vs. absent) varied between-participants by random assignment. Methods. 205 novice chart-users, tested between March 2011-March 2014, completed 64 trials where they saw real patient data presented on an observation chart. Each participant saw eight cases (four containing abnormal observations) on each of eight designs (which represented a factorial combination of the within-participants variables). On each trial, they assessed whether any of the observations were physiologically abnormal, or whether all observations were normal. Response times and error rates were recorded for each design. Results. Participants responded faster (scores present and absent) and made fewer errors (scores absent) using drawn-dot (vs. written-number) observations and an integrated colour-based (vs. non-integrated tabular) scoring-system. Participants responded faster using grouped (vs. separate) scoring-rows when scores were absent, but separate scoring-rows when scores were present. Conclusion. Our findings suggest that several individual design features can affect novice chart-users' ability to detect patient deterioration. More broadly, the study further demonstrates the need to evaluate chart designs empirically. [ABSTRACT FROM AUTHOR]

Aims and objectives To assess changes in perceptions of confidence and preparedness for practice of preregistration nursing students before and after the introduction of a capstone subject, and factors associated with perceptions of preparedness. Background Preregistration nursing student 'readiness' or 'preparedness' for practice has been highlighted in the literature in recent years, along with employer concerns that university graduate nurses are not work ready. Few studies have examined Australian preregistration nursing students' perceptions of preparedness for clinical practice following their final clinical placement or assessed whether preregistration student nurses' perceptions of preparedness change as the result of undertaking a capstone subject. Design A capstone subject was introduced at a regional northern Australian university in 2013. Perceptions of preparedness were assessed in two different cohorts of final year nursing students; one of which undertook a capstone subject. Methods Two separate cohorts of third year nursing students were surveyed regarding their perceptions of preparedness for practice at the conclusion of their final 240 hour clinical placement. The 2012 cohort did not experience a capstone subject, whereas the 2013 cohort were the first nursing students to experience the new capstone subject. Results Both cohorts were uncomfortable performing invasive procedures and reported low levels of confidence in the area of professional identity. An overall trend of decreasing confidence as patient assignment size increased was observed for both cohorts, and higher confidence was associated with previous health care experience. Perceptions of preparedness for practice did not increase significantly following the introduction of a capstone subject. Conclusions Although Australian undergraduate nursing student report feeling prepared for practice there are areas of knowledge, skills and patient care in which confidence is low. The results of this study highlight the importance of experience in building confidence and competence. Relevance to clinical practice This study highlights that while final year nursing students report feeling prepared for practice there are areas where additional support can be provided. It is recommended that nurse educators and health care facilities tailor their programs to provide support focused on the areas highlighted by this study. [ABSTRACT FROM AUTHOR]

Accessible Summary Recent evidence suggests that the interactional work of mental health nursing has been eroded and redirected to the task-based roles of medicine., This study utilized work sampling methodology to observe the proportion of time nurses working in a mental health setting spend in direct care, indirect care and service-related activities., Nurses spent 32% of their time in direct care, 52% in indirect care and 17% in service-related activities., Mental health nurses need to re-establish their therapeutic availability to maximize consumer experiences and outcomes., Abstract The foundation of mental health nursing has historically been grounded in an interpersonal, person-centred process of health care, yet recent evidence suggests that the interactional work of mental health nursing is being eroded. Literature emphasizes the importance of person-centred care on consumer outcomes, a model reliant upon the intimate engagement of nurses and consumers. Yet, the arrival of medical interventions in psychiatry has diverted nursing work from the therapeutic nursing role to task-based roles delegated by medicine, distancing nurses from consumers. This study used work sampling methodology to observe the proportion of time nurses working in an inpatient mental health setting spend in the activities of direct care, indirect care and service-related activities. Nurses spent 32 of their time in direct care, 52% in indirect care and 17% in service-related activities. Mental health nurses need to re-establish their therapeutic availability to maximize consumer experiences and outcomes. [ABSTRACT FROM AUTHOR]

Aim To evaluate the effect of early-warning scoring system design on the speed and accuracy of scoring. Background Despite the widespread implementation of early-warning scoring systems in hospitals, the speed and accuracy with which chart-users determine patients' early-warning scores has received minimal research attention. Design Within-subjects, with scoring-system design as the independent variable. Methods Forty-seven novice chart-users were presented with realistic vital sign observations recorded on charts with three different scoring-system designs. The rows for recording individual vital sign scores were either: (1) grouped together beneath all of the vital sign rows; (2) separated, with each row presented immediately below the corresponding vital sign row; or (3) excluded altogether. Participants' response times and error rates for determining the overall scores were measured for 54 time-points per design. Data were collected in December 2012-January 2013. Results Contrary to predictions, participants responded fastest and made the fewest errors when using the chart design without individual vital sign scoring-rows. For the other two designs, participants were faster when the rows for scoring individual vital signs were separated (vs. grouped), but accuracy did not differ. For both of these designs, significantly more time-points were affected by scoring errors compared with adding errors. Finally, data for patients with more serious derangements yielded greater response times and error rates on all three charts. Conclusion Early-warning scoring systems may be more effective without individual vital sign scoring-rows. Even when charts are designed by multi-disciplinary teams of human factors specialists and clinicians, empirical evaluations are essential. [ABSTRACT FROM AUTHOR]

SUMMARY Background Patients with end-stage kidney disease often have difficulty in adhering to aspects of their haemodialysis regimens. Objectives This study aimed to quantify the number of patients who attended 100% of their scheduled haemodialysis sessions, and the number of patients who gained no more than one kilogram per day between dialysis sessions, over a three-month period. Design Retrospective chart audit Participants Patients undergoing haemodialysis at an in-hospital centre in tropical Australia. Methods A renal nurse audited the 72 charts pertaining to a 12-week period in 2013. Results Patients attended 90.1% of all scheduled dialysis sessions. Forty-one patients attended all sessions, with the remaining 31 missing at least one scheduled session. One patient missed 16 scheduled sessions. The following were statistically less likely to attend all their scheduled sessions: Aboriginal and Torres Strait Islander patients; patients on a three times per week dialysis schedule; patients who had relocated from rural or regional towns and younger patients. The average daily weight gain ranged from 0.414 kg to 1.017 kg (mean = 0.885 kg). Younger patients were statistically less likely to adhere to fluid restrictions; patients without diabetes were more likely to adhere to the fluid allowances. Conclusions and applications to practice Renal services need to assist patients to adhere to their regimens. Initially, this service will examine strategies to maximise the likelihood of patients attending all of their dialysis sessions. Such an outcome will help to delay deterioration in the patients' health status, while minimising additional strain on the health service. [ABSTRACT FROM AUTHOR]