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Aim: To explore the health beliefs of clinical and academic nurses from Japan, Australia and China regarding wearing paper masks to protect themselves and others, and to identify differences in participants' health beliefs regarding masks. Background: The correct use of face masks and consensus among health professionals across the globe is essential for containing pandemics, and nurses need to act according to policy to protect themselves, educate the public and preserve resources for frontline health workers. Paper masks are worn by health professionals and the general public to avoid the transmission of respiratory infections, such as COVID‐19, but there appear to be differences in health beliefs of nurses within and between countries regarding these. Methods: This qualitative descriptive study used content analysis with a framework approach. Findings: There were major differences in nurse participants' beliefs between and within countries, including how nurses use paper masks and their understanding of their efficacy. In addition, there were cultural differences in the way that nurses use masks in their daily lives and nursing practice contexts. Conclusion: Nurses from different working environments, countries and areas of practice hold a variety of health beliefs about mask wearing at the personal and professional level. Implications for nursing policy and health policy: The COVID‐19 pandemic has sparked much discussion about the critical importance of masks for the safety of health professionals, and there has been considerable discussion and disagreement about health policies regarding mask use by the general public. Improper use of masks may have a role in creating mask shortages or transmitting infections. An evidence‐based global policy on mask use for respiratory illnesses for health professionals, including nurses, and the general public needs to be adopted and supported by a wide‐reaching education campaign. [ABSTRACT FROM AUTHOR]

New medicines can transform routines and priorities in clinical practice, but how do clinicians think and feel about these changes, and how does it affect their work? In Australia, the HIV prevention regimen pre‐exposure prophylaxis (PrEP) has been rapidly rolled out, transforming the sexual cultures and practices of users, but less attention has been given to the ways PrEP has reconfigured clinical practice. This paper draws on 28 qualitative semi‐structured interviews conducted between 2019 and 2020 with PrEP‐providing doctors and nurses in Australia to consider how they have affectively engaged with PrEP and put it into practice. Through a reflexive thematic analysis, we explore how clinicians adapted to PrEP, how the field of HIV prevention has been transformed, and how these developments have changed how clinicians approach patients. While the introduction of PrEP was initially received with uncertainty and shock, clinicians described PrEP as enjoyable to prescribe, and better aligned with the moral duties of sexual health consultations than existing HIV prevention strategies like condoms. Through approaching clinical work as an 'affective practice', we argue for attending not only to how new interventions change expectations and practices, but also how these changes are felt and valued by clinicians. [ABSTRACT FROM AUTHOR]

Objective: The need for more Remote Area Nurses in the Northern Territory is clear. This paper investigates the perspectives of Remote Area Nurse workforce issues among multiple stakeholders. The aim is to identify how Remote Area Nurse staffing issues are perceived by clinic managers, Remote Area Nurses themselves, Aboriginal colleagues and community members in seven remote communities in the Northern Territory. Design: This is a qualitative study that uses interviews and focus groups to identify key messages of local stakeholders about Remote Area Nurse workforce issues. A content analysis was used for data analysis. Setting: Seven diverse remote Aboriginal communities in the Northern Territory with government‐run health clinics were visited. Participants: Non‐random sampling techniques were used to target staff at the clinics at the time of field work. Staff and community members, who agreed to participate, were interviewed either individually or in groups. Interviews were conducted with 5 Managers, 29 Remote Area Nurses, 12 Aboriginal staff (some clinics did not have Aboriginal staff) and 56 community residents. Twelve focus groups were conducted with community members. Results: Content analysis revealed that participants thought having the "right" nurse was more important than having more nurses. Participants highlighted the need for Remote Area Nurses to have advanced clinical and cultural skills. While managers and, to a lesser extent, Remote Area Nurses prioritised clinical skills, Aboriginal staff and community residents prioritised cultural skills. Conclusions: Participants identified the importance of clinical and cultural skills and reiterated that getting the "right" Remote Area Nurse was more important than simply recruiting more nurses. Thus, retention strategies need to be more targeted and cultural skills prioritised in recruitment. [ABSTRACT FROM AUTHOR]

LARSEN A-C. Nursing Inquiry 2012; 19: 334-344 Trappings of technology: casting palliative care nursing as legal relations Community palliative care nurses in Perth have joined the throng of healthcare workers relying on personal digital assistants (PDAs) to store, access and send client information in 'real time'. This paper is guided by Heidegger's approach to technologies and Habermas' insights into the role of law in administering social welfare programs to reveal how new ethical and legal understandings regarding patient information add to nursing's professional responsibilities. This qualitative research interprets data from interviews with twenty community palliative care nurses about clients' legal rights to informational privacy and confidentiality. It explores nurses' views of their nursing responsibilities regarding clients' legal rights, liability issues, bureaucratic monitoring and enforcement procedures. It concludes that nurses and clients are construed as legal subjects entrenched in legal relations that have magnified since these nurses began using PDAs in 2005/2006. [ABSTRACT FROM AUTHOR]

Reducing and eliminating the use of restrictive practices, such as seclusion and restraint, is a national priority for Australia's mental health services. Whilst legislation, organization and practice changes have all contributed to a reduction in these practices, forensic mental health services continue to report high rates. This paper details the findings of research that examined the experiences of nurses working in the inpatient forensic mental health setting. The research aimed to (i) document the experiences of nurses working in the forensic mental health setting, (ii) articulate their perceived unique skill set to manage challenging patient behaviours, and (iii) determine how their experiences and skill set can inform practice changes to reduce the use of restrictive practices. Thirty‐two nurses were recruited from one Australian forensic mental health service. Data were collected using semi‐structured interviews and analysed using inductive content analysis. Four categories were identified that influenced practice experiences: (i) working in a challenging but interesting environment, (ii) specialty expertize, (iii) exposure to aggression and resilience as a protective factor, and (iv) the importance of effective teamwork and leadership. Forensic mental health care is complex, highly specialized, and often delivered in an unpredictable environment. Whilst high rates of restrictive practices may be linked to the unique characteristics of forensic patients, training, teamwork, and leadership are critical factors influencing their use in this setting. Nurses working in this area need to be educated and supported to work confidently and safely with this high‐risk patient cohort. [ABSTRACT FROM AUTHOR]

An international nurse shortage, tightening fiscal constraints, and increased service demands have seen health systems increasingly turn to employing assistants in nursing ( AIN) as a cost-effective means to meet demand. This paper describes social positioning from the perspective of 11 AIN who were employed to work in specialist mental health settings in a metropolitan health service in Sydney. Data was collected by means of semistructured interviews. Interview questions encouraged AIN to explore their experience with reference to positioning within the service, role perception, role development, staff relationship, and role satisfaction. Thematic analysis was utilized to generate themes and explore meaning within the data. The following themes emerged: role definition and clarity; socialization and adaptation; and enhancing education. Analysis suggests that whilst AIN were integrated into mainstream service, the scope of activities or role remains geographically variable and inconsistent. Encouragingly, as AIN became familiar with their work environments and teams, they considered themselves to be of value and were able to play a meaningful role. A desire for learning and a need for continuing education also emerged as a primary theme. Findings from the data suggest that AIN in the mental health setting remain a novel and, to some extent, poorly utilized resource. [ABSTRACT FROM AUTHOR]

MAPEDZAHAMA V, RUDGE T, WEST S and PERRON A. Nursing Inquiry 2012; 19: 153-164 [Epub ahead of print] Black nurse in white space? Rethinking the in/visibility of race within the Australian nursing workplace This article presents an analysis of data from a critical qualitative study with 14 skilled black African migrant nurses, which document their experiences of nurse-to-nurse racism and racial prejudice in Australian nursing workplaces. Racism generally and nurse-to-nurse racism specifically, continues to be under-researched in explorations of these workplaces; when racism is researched, the focus is nurse-to-patient racism and racial prejudice. Similarly, research on the experiences of migrant nurses from a variety of ethnicities in Australia has tended to neglect their experiences of the social dynamics of the workplace, thus reinforcing their racialisation. When racialised, the migrant nurse becomes 'the problem' through a focus on English language competency and ensuing communication barriers. This paper applies Essed's framework of 'everyday racism' to theorise narratives of racism by black African migrant nurses in Australia. In so doing, it not only brings to the fore silenced discussions of nurse-to-nurse racism in Australia, but also exposes the subtle, mundane nature of contemporary racism. For this reason, while the data we present must be read within their context, that is, the Australian nursing workplace, it has significance for advancing a critical analysis of racialised minority groups' experiences of racism within seemingly 'race-less' nursing workplaces internationally. [ABSTRACT FROM AUTHOR]

Despite recent changes to mental health policy in Australia and overseas, physical restraint continues to be widely employed in mental health services. While mental health nurses have a critical role to play in supporting initiatives designed to reduce restraint, it is unclear how they feel about moves to restrict the use of prone restraint. In this qualitative study, focus group interviews were conducted with mental health nursing staff and lived experience workers (LEWs) to gain their perspectives on the use of physical restraint in general and the restrictions being placed on prone ('face down') restraint. Five themes emerged: justifying the need for restraint, reliance on the prone position, the position is not the issue, time limits, and the psychological impact. Although mental health nurses were concerned about the risks associated with physical restraint, they provided strong justification for continued use of the prone position. LEWs raised concerns about the psychological impact of prone restraint and noted the need for a greater emphasis on de‐escalation and other restraint avoidance strategies. The findings highlight the complexities and challenges to be considered when developing initiatives to reduce reliance on the use of restraint in general, and prone in particular. [ABSTRACT FROM AUTHOR]

The Nursing and Midwifery Board of Australia's Code of Conduct for Nurses sets out the professional behaviour and conduct expectations for nurses in all practice settings. The publication of a revised version in 2018, which included expectations related to culturally safe and respectful practice and Aboriginal and Torres Strait Islander Peoples' health, caused reverberations beyond the profession of nursing. A controversy that the changes required nurses to verbally apologize for being white before their interactions with Aboriginal and Torres Strait Islander people gained the attention of the mainstream media. This interpretation, which came from outside nursing, was disputed by the Board. Challenged by these events, the authors were interested in understanding the actual impacts of the changes from the perspectives of nurses in practice. This research, carried out nearly three years after publication, has focused specifically on the speciality of mental health nurses in this context. The objective of this research was to undertake a social analysis focused on the impact that changes in the Code have had on the culture of mental health nursing utilizing a qualitative methodology. Eight mental health nurses were interviewed. The research found that there was little evidence of any impact on mental health nursing practice. Many of the participants were unaware of the amendments to the Code, whilst those nurses who were aware did not perceive that it had led to any real change within mental health nursing or service delivery. [ABSTRACT FROM AUTHOR]

Purpose: COVID‐19 has presented health care professionals with unprecedented challenges. Significant risks have emerged as nurses have continued to work in delivering frontline health care during the pandemic. Feeling "at risk" has significant deleterious effects on nurses. The study sought to explore the perceptions of risk by Australian primary health care nurses (PHC) during COVID‐19. Methods: Twenty‐five Australian PHC nurses were purposively recruited from survey respondents who indicated a willingness to be interviewed. Phone interviews were undertaken between June and August 2020. Audio‐recordings were transcribed and analyzed thematically. Findings: Participants shared concerns about risks in the workplace that emerged during COVID‐19 and described the strategies used to mitigate these identified risks. Three themes were identified: (a) Professional concerns, (b) Personal/family concerns, and (c) Patient needs. Conclusions: Understanding PHC nurses' perceptions of risk during COVID‐19 provides an important insight into how they can be better supported to manage the risks that they face and feel safer in their workplace. Ensuring that PHC nurses are well‐supported is important to optimize job satisfaction, reduce burnout and improve patient care. Clinical Relevance: There is a need to ensure that nurses feel safe during crises such as pandemics to protect both individual nurses and the broader workforce. Protecting the health workforce is essential to optimizing service delivery and promoting health outcomes. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to explore how nurses and midwives (trained at Flinders University in Adelaide) from rural, remote and urban locations view the impact of cultural safety training on their practice and the extent to which they incorporated cultural safety principles into their practice. Design: qualitative research study. Setting: rural, remote and urban locations across Australia. Participants: Nurses and midwives who had undertaken cultural safety training at Flinders University as part of their undergraduate degree. Methods: Participants were recruited for semi‐structured interviews. Interviews were recorded and transcribed verbatim. Transcripts were coded independently by members of the research team. Main outcome measures: The use of cultural safety principles in participants' practice, and the extent to which they were applied, was determined. Barriers and enablers to enacting cultural safety in the workplace were also identified. Results: 10 individuals participated in an interview (7 nurses and 3 midwives). The Modified Monash Model was used to classify participant location with the following observed: MM1, six; MM2, two; MM5, one; MM6, one. 3 participants were from the Northern Territory and 7 from South Australia. Participants were at varying stages in their journey of cultural safety, ranging from early stages to those able to embody the Cultural Safety Principles and negotiate barriers to provide culturally safe care. Educational strategies for participants to progress their cultural safety journey were also identified. Conclusion: The extent to which cultural safety principles are applied in practice is diverse amongst the nurses and midwives that participated in this study, demonstrating that cultural safety is a journey and ongoing support is needed. [ABSTRACT FROM AUTHOR]

The aim of this Australian based qualitative study was to better understand key drivers for mental health nurses to undertake training in psychotherapy, and how these capabilities are integrated into their clinical practice. Open ended reposes from a national survey of 153 mental health nurses were supplemented with data from 12 semi‐structured interviews of nurses with rich experience of integrating psychotherapy and mental health nursing capabilities. Key findings emerging from the thematic analysis were that mental health nurses are providing uniquely holistic psychotherapeutic services to consumers with often complex conditions, despite overtly hostile clinical and policy contexts. These often very well qualified mental health nurse psychotherapists are different to the traditional identity of either a nurse or psychotherapist. Recommendations from the findings of this study are that where appropriately qualified, mental health nurses be granted eligible provider status for existing Medicare funding items. Finally, training and building foundational capabilities in psychotherapy is highly recommended for all mental health nurses. [ABSTRACT FROM AUTHOR]

Aim: This study explores Australian clinical nurses' and midwives' familiarity with a new code of conduct and understanding in what ways the code is important for nurses as they carry out clinical practice. Background: Codes specify the expectations of nurses' responsibilities, legal requirements, behaviour and conduct. Being familiar with the code is central to being a professional nurse or midwife. As nursing continues to advance, updating the code is crucial to maintain professional and safe practice. Design: This project utilized a cross‐sectional descriptive design. Methods: A survey was developed incorporating Likert‐type scale assessments of the 7 value statements from the 2018 Australian Nurses' Code of Conduct for familiarity and importance. The survey included open‐ended questions to elicit clinical nurses' experiences of conduct breaches, opinions regarding usefulness and relevance of the code for current practice. Data were collected at an acute care hospital in Sydney during January 2018. Results: Significant differences relating to cultural and patient‐centred approaches were revealed in the study. The new value involving the role of research was least understood and ranked least important by nurses and midwives. Professional 'integrity' resonated with participants when considering the behaviour of nurses, and short, unambiguous values were the most popular. Additionally, a substantial number of participants had no knowledge of the code or were not aware of the recently revised version. Conclusion and implications for nursing: A code of conduct provides structure and guidance for workplace values and principles. A respected code is important to the nursing profession to help prevent inappropriate and incompetent behaviour and as a guide for nursing performance. Nurses in this study claimed the code was highly relevant to their work as a nurse and was incorporated into their daily practice. [ABSTRACT FROM AUTHOR]

Nurses caring for adolescent consumers with anorexia nervosa in the inpatient setting are challenged in a unique way, in that they are caring for people with whom they do not have a mutually held concept of well‐being. Their efforts to ensure weight gain are frequently against the wishes of the consumer. This dissonance results in challenging interactions, where nursing care and authority may be undermined. This study investigated the dynamics of nurses' authority within this context. Interviews with nurses (n = 10) were conducted and analysed through thematic analysis. Nurses reported that consumers, compelled by the psychopathology of anorexia nervosa, often sought to challenge or undermine their authority. Some nurses experienced the opposition and conflict as demoralizing, whereas others were able to maintain confidence in the therapeutic merit of their care. Younger, inexperienced nurses in this study were particularly vulnerable to interactions that mitigated their authority, due to their tendency to engage in friend‐like relationships. Nurses caring for adolescents with anorexia nervosa should be prepared to be confronted by interactions that overtly and surreptitiously undermine their capacity to exercise professional authority. It is important that nurses recognize the importance of maintaining their authority, and how it can be threatened in subtle and unexpected ways. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Research exploring nurses' experiences working with families in paediatric intensive care unit ( PICU) is limited. No studies have been undertaken in a mixed adult-paediatric ICU. Objectives To explore nurses' perceptions of working with families of critically ill children in a mixed adult-paediatric intensive care unit ( ICU). Design Descriptive qualitative design. Methodology Five PICU nurses participated in semi-structured interviews. Data were analysed using thematic analysis. Trustworthiness was enhanced using an audit trail, member checks and peer review of all data. Results Three main themes and one overarching theme emerged. Role confusion and delineation examined the roles which nurses ascribed to themselves and the families; and demonstrated the conflict which could arise if roles were challenged. Information sharing demonstrated the positive and negative ways in which nurses utilized information with families in their daily practice. The contextual environment of the PICU scrutinized the physical, cultural and institutional factors which impacted on the nurses' ability to work with families in the PICU. Finally, the overarching theme Competing values explores the interplay between the nurses' personal values and those of the PICU and the institution. Conclusions Working with families in a mixed adult-paediatric ICU is influenced by multiple personal and institutional factors. The value placed on families and on the time nurses spent with them often competed for priority with nurses' other values and the wider culture of the PICU. The potential for role confusion, the management of information and the physical environment of the PICU further contributed to variability in nurses' working with families. Relevance to clinical practice The results highlighted a need for education for both nurses and medical staff who work with families of critically ill children. Additionally, the need for each PICU to have a written policy on family presence and participation is crucial to guide practice and maintain continuity of care. [ABSTRACT FROM AUTHOR]

Australia, along with other countries, has introduced New Public Management (NPM) into public sector hospitals in an effort to contain healthcare costs. NPM is associated with outsourcing of service provision, the meeting of government performance indicators, workforce flexibility and rationing of resources. This study explores the impact of rationing of staffing and other resources upon delivery of care outside of business hours. Data was collected through semistructured interviews conducted with 21 nurses working in 2 large Australian metropolitan hospitals. Participants identified four strategies associated with NPM which add to workload after‐hours and impacted on the capacity to deliver nursing care. These were functional flexibility, vertical substitution of staff, meeting externally established performance indicators and outsourcing. We conclude that cost containment alongside of the meeting of performance indicators has extended work traditionally performed during business hours beyond those hours when less staffing and material resources are available. This adds to nursing workload and potentially contributes to incomplete nursing care. [ABSTRACT FROM AUTHOR]

Emergency department nurses are challenged to provide safe, quality care to older people; however, nurses' perceptions of their role and experiences are seldom investigated. This focus-group study investigated emergency department nurses' perceptions and experiences of caring for older people, using four focus groups of nurses with a minimum three months' experience in the emergency department and a demographic survey. Data were thematically analyzed. Two themes emerged. The first was the clash of expectations between nurses and family/carers related to safety and quality of nursing care. Older people were perceived to be vulnerable in the emergency department, and nurses were frustrated that competing priorities decreased their ability to ensure them safe and quality care. Nurses felt family/carers were disappointed with care provided, and might not empathize with or understand their predicament. The second theme concerned nurses' perception that family/carers could provide a safety net for the older person in the emergency department in times of high workload. Nurses need support to care for older people in the emergency department to ensure safe and optimal care, and a shared understanding of care provision between nurses and family needs development. [ABSTRACT FROM AUTHOR]

A significant international development agenda in the practice of nurses supporting families with young children focuses on establishing partnerships between professionals and service users. Qualitative data were generated through interviews and focus groups with 22 nurses from three child and family health service organisations, two in Australia and one in New Zealand. The aim was to explore what is needed in order to sustain partnership in practice, and to investigate how the concept of practice architectures can help understand attempts to enhance partnerships between nurses and families. Implementation of the Family Partnership Model (FPM) is taken as a specific point of reference. Analysis highlights a number of tensions between the goals of FPM and practice architectures relating to opportunities for ongoing learning; the role of individual nurses in shaping the practice; relationships with peers and managers; organisational features; and extra-organisational factors. The concept of practice architectures shows how changing practice requires more than developing individual knowledge and skills, and avoids treating individuals and context separately. The value of this framework for understanding change with reference to context rather than just individual's knowledge and skills is demonstrated, particularly with respect to approaches to practice development focused on providing additional training to nurses. [ABSTRACT FROM AUTHOR]

To explore Australian nurse scholars' personal and professional perspectives on the nature and development of contemporary Australian scholarship, including its facilitators and barriers. A qualitative exploratory design, with snowball sampling, identified 13 well-regarded nurse scholars from Australian universities or clinical health services. Semistructured, in-depth interviews were conducted in 2008-2009, and transcripts of data were subjected to Morse's content analysis method. Four themes with supporting subthemes emerged: Views on Scholarship; Locations; Facilitators and Barriers; and Visioning the Future. New and reinforced information about Australian nursing scholarship was revealed. The study revealed contemporary Australian perspectives on nursing scholarship. It included participants' personal and professional histories; definitions of the attributes of scholars; mentoring; and that educational and practice maturity contribute to contemporary definitions of nursing scholarship. Scholars, working in either academic or practice environments, provided points of difference on scholarship. High workloads associated with curricula, lack of recognition of a scholar's achievements, and securing research funding were seen as barriers to scholarship. Moreover, current scholars are aging, and there is a looming shortage of scholars prepared for the future. Urgent attention needs to be paid to capacity building of clinicians and academics for the future scholarship of Australian nursing. Scholarship is seen as the hallmark of the intellectual pursuit of knowledge and understanding and is essential for the practice of nursing and improvements to health. Educators, policy makers, and nursing leaders need to clearly develop strategies to sustain Australian nursing scholarship for the future. [ABSTRACT FROM AUTHOR]

Consumer participation in the education of health professionals is increasing, particularly in mental health nursing education and storytelling remains the most frequent approach to consumer involvement. The use of story has tended to be accepted as a legitimate educational tool with limited critique or consideration of its potential consequences presented within the academic literature. A qualitative exploratory research study was undertaken with mental health nurse academics ( n = 34) and consumer educators and academics ( n = 12), to investigate the perceptions and experiences of mental health nurses and consumers regarding the involvement of consumers in mental health nursing education. Data were analysed thematically. Story was a major theme to emerge from consumer participants and received some attention from nurse academics. Consumers and nurses both referred to the power of story to convey the human experience of mental illness diagnosis and service use; and the vulnerability that can result from storytelling. Consumers also described: story as expectation; preparation and support; and the politics of story. All participants supported the value of storytelling in mental health nursing education. Consumers had considered the complexities in far greater detail. The ongoing value of story as an educational technique requires further research. Equally important is considering a broader range of educational roles for mental health consumers. [ABSTRACT FROM AUTHOR]