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Objective The literature reports nursing academics avoid manikin-based simulation because they feel intimidated by the technology. With that in mind we sought to design a manikin-based simulation learning experience for nursing students, with low technological burden for those nursing academics expected to work with the technology. Setting A multi-campus Australian regional university school of nursing. Subjects Nursing academics with little or no experience in manikin-based simulation. Primary argument Nursing academics are encouraged to use manikins in their clinical teaching but little has been done to address their fears and concerns around the technology. We argue that taking simple steps to decrease the technological burden will help to encourage nursing academics uptake of manikin-based simulations, as a favoured pedagogy in clinical teaching. Conclusion The technological burden around manikin-based simulation was reduced by: (1) choosing medium level fidelity simulations, (2) designing simulations where students operate the equipment, (3) preparing participants for the SLE with a pre-brief video and instruction handouts, (4) offering academics roles as observers, and (5) providing on-site technological support. Nursing academics were encouraged by the process and more inclined to engage with manikin simulations. Designing simulations that address nursing academics' fears and concerns around simulation technology encourages simulation uptake. [ABSTRACT FROM AUTHOR]

Objective: This article aims to address knowledge gaps and misconceptions among healthcare professionals regarding needle selection (specifically the length and gauge/size chosen) for intramuscular (IM) and subcutaneous (SC) injections. It investigates the impact of needle selection on injection efficacy and adverse effects, considering factors, such as, needle length, size, patient characteristics, and medication requirements. It also aims to evaluate current injection guidelines against research findings from the past two decades, identifying areas requiring revision or updating. Methods: The discussion paper employs a literature review, including an analysis of past research that employs imaging techniques, such as, CT and ultrasound to examine tissue depth in both IM and SC injection practices; the author's extensive experience across various clinical settings, including immunisation, primary care, and acute care settings. The author's roles as academic staff and a clinical facilitator allow for the identification of gaps between theoretical knowledge and practical implementation in injection practices. These insights contribute to a comprehensive understanding of the challenges faced by healthcare professionals. Results: The study reveals significant discrepancies in needle selection practices, with traditional methods often diverging from evidence-based recommendations. Challenges noted include reliance on needle hub colour coding for IM and SC injections and insufficient understanding regarding the rationale behind these injection methods. Another additional barrier is interpreting needle packaging information to identify the actual needle length for injection. Staff training and education is essential to improving accuracy and safety in injection practices. Further, patient characteristics, such as, weight, BMI, gender, and injection sites were found to impact needle selection, highlighting the need for tailored approaches. The article suggests that inconsistent and outdated guidelines from various agencies in injection practices and techniques often lack robust scientific rationale. Implications for research, policy, and practice: The findings and recommendations have significant implications for healthcare policies and guidelines. They highlight the need to incorporate research findings to update current guidelines, ensuring safe and effective injection practices across all clinical settings. An algorithmic flow chart could be developed to reflect the above concerns. What is already known about the topic? * Nursing textbooks often differ in IM and SC procedures, with some based on non-evidence-based recommendations. * Unsafe injections have severe consequences, including increased morbidity and mortality, along with substantial medical costs. * Complications like muscle fibrosis, abscesses, gangrene, and nerve injury may arise. Inappropriate injections can result in subtherapeutic absorption and reduced medication efficacy. What this paper adds: * This article highlights the overreliance on traditional practices in injection procedures and advocates for nurses to embrace evidence-based approaches in their injection techniques. * It also emphasises the importance of proper needle selection, including the correct identification of length and gauge/size (rather than relying solely on the needle colour hub for IM/SC injections), to ensure medication efficacy and patient safety. * This shift towards best practice is anticipated to enhance nursing proficiency in intramuscular and subcutaneous injections, ultimately leading to improved patient outcomes. [ABSTRACT FROM AUTHOR]

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

Aim: A discussion of empathy and compassion including patient and nursing perspectives, barriers and enablers, and the potential for development, teachability, and sustainability of empathy and compassion in nursing. Background: Whilst compassion and empathy have long been recognised as prerequisites for the provision of effective nursing care, there are many interpretations of their meanings and the two are often transposed. The presence or absence of compassionate and empathetic nursing care has multiple positive and negative effects on nursing satisfaction and retention and on patients' experiences and health outcomes. Design: Discussion paper. Data Sources: Embase, Emcare, Medline, ProQuest, and PubMed were searched from 1 January 2015 to 16 January 2023 for scholarly journals with full text articles in the English language. Conclusion: Compassion and empathy are sine qua non in the provision of nursing care. Empathy is a core component of compassion. Compassion and empathy may be innate characteristics, but they can also be taught and fostered through education both pre- and post-graduation, which is based on experiential rather than didactic methods of teaching. Organisations have a pivotal role in supporting a compassionate environment through their leadership by developing policies and practices to ensure appropriate staffing levels, having consideration for skill mix and workload which will facilitate the provision of compassionate and empathetic nursing care leading to improved patient outcomes and satisfaction, and also increase nursing job satisfaction and retention. Implications for research, policy, and practice: Pre- and post-graduate nurses in particular, should have access to targeted education and support from peers, senior nurses, and educators, especially positive role modelling. For all nurses to be able to provide compassionate care, it is important that organisations' leadership and management recognises the time required to do so without pressure to complete clinical tasks. Indisputably, the prevailing clinical implication is that reducing staffing shortfalls and excessive workloads is essential to foster a compassionate environment. What is already known about the topic? • Compassion is a prerequisite for the provision of effective, person-centred patient care. • Empathy and compassion are often used interchangeably and there is some confusion between the two. • Absence of compassion has a detrimental effect on patient experiences and outcomes together with nursing job satisfaction and retention rates. What this paper adds • Whilst empathy is considered a separate concept from compassion, it has also been identified as a core component of compassion creating some perplexity. • It is possible to effectively teach empathy and compassion using non-didactic, experiential strategies both pre- and post-graduation. • Organisations play a pivotal role in supporting a compassionate environment which positively impacts on nursing satisfaction and retention rates thereby improving patients' experiences and health outcomes. [ABSTRACT FROM AUTHOR]

Objective: The objective of this environmental scan is to synthesize the published, peer-reviewed literature specific to the term 'environmental scan' to determine how it is currently being used in health research and to propose some promising practices. Background: Environmental scans are becoming increasingly popular in synthesizing information on emergent topics and describing practice and research scope. Despite the growing use of environmental scans in health research, including nursing and rehabilitation, limited attention is given to methodological best practices. It is essential that we develop knowledge in this area to assist researchers, trainees, healthcare professionals, educators, and decision-makers with the use and reporting of environmental scans. Study design and methods: This environmental scan included a search of four health databases: CINAHL, Embase, MEDLINE, and PsycINFO. We included peer-reviewed studies published between 2000-2024 in English using two key terms, 'environmental scan' and 'health'. Studies were included that described methods used in conducting an environmental scan. Results: We identified 56 studies describing methods for conducting environmental scans. A synthesis of these studies revealed four promising practices: 1) consider environmental/contextual influences, 2) use of multiple data sources and approaches, 3) engage stakeholders to ensure relevance/need and increase uptake, and 4) use of outcomes to address knowledge or service gap to optimise impact. Conclusion: The findings of this environmental scan are among the first to examine methodological studies to determine promising practices for conducting environmental scans across health disciplines. Implications for research, policy, and practice: * The findings of this novel environmental scan are beneficial for health professionals, researchers, trainees, educators, and decision-makers in informing research, practice, and policy change What is already known about the topic? * The use of environmental scans is becoming increasingly popular in health research, including nursing and rehabilitation. * There is a lack of consistency in the use and reporting of environmental scans across health disciplines. What this paper adds * This environmental scan is among the first to contribute foundational knowledge and innovation in promising best practices for the conduct of environmental scans in health research. * The novel findings will assist in promoting consistency in the use and reporting of environmental scans. [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact of workplace factors on psychological distress in New Zealand registered nurses. Background: Nurses are often faced with challenging work environments, with long work hours, high patient ratios, and emotionally charged situations that cause stress. Despite the well-established links between the nurse work environment and well-being, there remains a gap in the literature around the role of workplace factors on psychological distress in nurses. Study design and methods: A cross-sectional survey was conducted with registered nurses in New Zealand. Depression, anxiety, and stress were self-reported using the DASS-21, while difficult practice environments and negative workplace acts were self-reported using PES-NWI and NAQ-R. Descriptive and inferential statistics were undertaken using SPSS. STROBE guidelines were used to report the study. Results: 480 RNs completed the survey. On average, depression, anxiety, and stress scores were 6.08 (SD=7.06, Normal), 4.87 (SD=6.05, Normal), and 9.50 (SD=7.30, Normal), respectively. The Average PESNWI score was 2.70 (SD=0.54), while the average total NAQ-R score was 34.27 (SD=12.67). Depression, anxiety, and stress scores were positively associated with NAQ-R scores, and negatively associated with PES-NWI scores (p-values <0.05). PES-NWI score was negatively associated with NAQ-R score (p<0.05). PES-NWI and NAQ-R explained 28.8%, 15.6%, and 26.1% of the variation in depression, anxiety, and stress, respectively. Depression, anxiety, and stress were significantly associated with intention to leave (p-values <0.05). Depression and anxiety were significantly associated with ethnicity (p-values <0.05). Age was negatively associated with anxiety and stress (p-values <0.05). Years employed as a nurse were also negatively associated with anxiety (p<0.05). Discussion: This study addresses a knowledge gap by demonstrating that workplace factors are associated with psychological distress in nurses. Conclusion: Psychological distress in nurses is significantly associated with the work environment and with intention to leave the profession. Given that most countries are facing nurse shortages and are actively recruiting nurses from diverse countries and ethnic backgrounds, targeted and individualised support needs to be provided to preserve nurses' mental health and subsequent retention in the workforce. Implications for research, policy, and practice: Healthcare providers must prioritise modifying the work environment to address the factors contributing to nurses' psychological distress. This includes providing culturally tailored mental health resources and support for nurses with diverse backgrounds and experiences. Future research should examine how organisational-level strategies can reduce psychological distress in nurses. What is already known about the topic? * Psychological distress is common in nurses. * Indicators of psychological distress include non-specific symptoms of stress, anxiety, and depression. * Psychological distress is associated with challenging working conditions. What this paper adds: * Vulnerable groups, such as nurses from specific ethnic backgrounds and less experience, report higher levels of psychological distress, such as anxiety and depression. * The quality of the practice environment is associated with psychological distress in registered nurses. * Negative acts in the workplace (i.e., bullying and harassment) are positively associated with psychological distress in registered nurses. [ABSTRACT FROM AUTHOR]

Objective: To establish the association of the mother's breastfeeding self-efficacy with infant feeding in the first six months of the child's life and identify the mothers' perception of their confidence to breastfeed. Background: Breastfeeding is a multi-determined process. Many factors contribute to a mother's ability to exclusively breastfeed until a child reaches six months of age. Among these factors is a mother's confidence in her abilities to breastfeed her baby, referred to as breastfeeding self-efficacy. Thus, self-efficacy for breastfeeding could be an essential predictor of reducing the risk of early weaning. Study design and methods: This is a mixed-method sequential explanatory study. The short form of the Breastfeeding Self-Efficacy Scale was used to determine the level of the mothers' confidence. 158 mothers were surveyed during their postpartum hospital stay, and 128 were included in a follow-up six months after delivery. Additionally, 22 participants were randomly selected for an in-depth interview (qualitative stage). Data were analysed using inferential statistics and thematic content analysis. Results: High levels of breastfeeding efficacy were identified during the hospitalisation and after discharge among all participants. Exclusive breastfeeding was practised among 45.31% of mothers six months after delivery. Return to work was a key factor contributing to early weaning. Family and health professional support during the breastfeeding process were associated as crucial for the duration of exclusive breastfeeding. Discussion: Exclusive breastfeeding for the first six months after delivery involves various factors, such as the mother's confidence in her breastfeeding skills and the specific circumstances she faces while breastfeeding. Thus, through the mixed qualitative and quantitative approaches, it was possible to identify the convergence of self-efficacy scores and the breastfeeding mothers' perception of their confidence and intention to maintain exclusive breastfeeding. Conclusion: High self-efficacy to breastfeed alone was not enough to maintain exclusive breastfeeding. It is necessary to combine self-efficacy and family or health service support and guidance to clarify the mother's doubts about potential difficulties that may appear throughout the breastfeeding process, the maintenance of lactation when she plans to return to work, and the breastfeeding technique. Implication for practice: Applying the Breastfeeding Self-Efficacy Scale associated with the breastfeeding mothers' interview during the prenatal and perinatal period facilitates early identification of mothers at risk for early weaning and helps nurses in planning interventions to support the breastfeeding mother and her child in favour of exclusive breastfeeding duration. What is already known about the topic? * Exclusive breastfeeding (EBF) is recommended for the first six months of a child's life; however, many mothers do not follow this recommendation due to multiple barriers such as mental health issues (i.e., postpartum depression or anxiety), educational gaps, physical discomfort like sore nipples, engorgement, return to work, and lack of support. * Breastfeeding self-efficacy has been associated with the duration of breastfeeding. What this paper adds * Breastfeeding mothers' self-efficacy is essential for stimulating maintenance. * Questions 3 (I always feed my baby without using powdered milk as a supplement) and 11 (I always breastfeed my baby on one breast and then switch to the other) of the Breastfeeding Self-Efficacy Scale (short form) predicted early weaning risk. * Planning nursing care intervention for breastfeeding mothers in their follow-up after birth should include assessing their breastfeeding self-efficacy and factors that could contribute to early weaning, such as returning to work and the lack of a support network. [ABSTRACT FROM AUTHOR]

Objective: To explore advanced practice nurses' experiences and perceptions of running nurse-led clinics in the Australian context. Background: Advanced practice nurses consult with patients through nurse-led clinics to address ever-growing clinical demands and healthcare workforce shortages. Their experiences and perceptions of running nurse-led clinics are vital, but studies offering insights into this area are scarce. Study design and methods: This study adopted a qualitative descriptive design. Using purposive and snowball sampling methods, ten semi-structured individual virtual interviews were conducted with advanced practice nurses who run nurse-led clinics in Australia. Interviews were audio recorded and transcribed verbatim. Data were analysed using thematic analysis. Reporting of this study adhered to Consolidated Criteria for Reporting Qualitative Research guidelines. Results: Three themes were constructed: 1) the genesis of nurse-led clinics; 2) perceived positive outcomes of nurse-led clinics; and 3) contextual determinants influencing nurse-led clinics. Findings show that nurses establish, manage, and expand nurse-led clinics to fulfil health service demands and patients' care needs. Though advanced practice nurses reported positive outcomes, there were several barriers that need to be addressed at all levels. Discussion: Advanced practice nurses are required to have wide-ranging knowledge and skills across the validated domains of patient care, support of systems, education, research, and professional leadership to be able to provide evidence-based holistic care. Advanced practice nurses face obstacles in running nurse-led clinics with overwhelming workloads and insufficient support. Regular communication with healthcare organisational leadership and collaboration with other healthcare workers is crucial to gain recognition and support. Conclusion: Nurse-led clinics are a valuable service that should be promoted and recognised. It is the responsibility of healthcare organisations to review current policies and provide necessary support to advanced practice nurses to enable effective and efficient nurse-led services. It is also incumbent upon governments to support funding that enables nurse-led care models across policy, funding, and healthcare levels, spanning macro-, meso-, and micro-levels. Implications for research, policy, and practice: Advanced practice nurses as participants shared experiences in establishing, running, and expanding nurse-led clinics, that can provide a framework to other nurses wanting to start nurse-led services. Advanced practice nurses are encouraged to promote their work to gain recognition and create awareness of the role of nurses in the provision of nurse-led services. More studies are needed at the global level to understand advanced practice nurses' experiences and the challenges they encounter which will assist in developing the strategies to address these barriers. What is already known about the topic? * Nurse-led clinics were introduced to mitigate the shortage of healthcare resources, accommodate increasing clinical demands, and enhance patients' experiences. * Nurse-led clinics achieve positive outcomes, however, advanced practice nurses face barriers in running nurse-led clinics. * Studies offering insights into Australian advanced practice nurses' experiences and perceptions of running nurse-led clinics are lacking. What this paper adds? * Advanced practice nurses shared experiences in establishing, running, and expanding nurse-led services which can be adopted to guide nurses new to nurse-led services. * Advanced practice nurses strived to overcome obstacles encountered in running nurse-led clinics. They need support at all levels to implement nurseled services successfully. * As this is the first study of its kind in Australia, more research is needed to promote and improve the awareness of nurse-led clinics both in Australia and globally. [ABSTRACT FROM AUTHOR]

Objective: This paper discusses contemporary patient assessment requirements and how they articulate with expert nursing practice. Background: Contemporary patient assessment requirements are intended to standardise the conduct, collection and documentation of patient needs and risks. Current assessment requirements are designed to be applied uniformly for both expert and novice nurses' alike to ensure consistency in the process and documentation of assessment. The requirements for patient assessment have grown in complexity over time but there is a paucity of evidence that considers how those requirements impact the work of expert nurses. Discussion: This discussion paper reflects on individual aspects of these issues such as how experts develop their practice, the elements of assessment requirements, how and why assessment requirements have changed over time. Expert nurses develop practice over time that is shaped by exposure to a wide range of clinical scenarios and learning experiences. Expert practice is partly defined by an ability to quickly identify key elements of a patient's condition based on past experiences where the expert has learnt to recognise and predict patterns of care needs. The literature identifies a number of risks inherent with current assessment requirements, many of which are poorly recognised. Disproportionate focus on documentation compliance can reframe nurses' practice away from assessing patient needs towards the process of assessment documentation instead. A lack of flexibility in assessment practice risks reducing the expert nurses' ability to respond to the individual needs of a patient and tailor care uniquely designed for their needs. Repetition and duplication of data collection unintentionally embedded within the assessment process, risks impacting the efficiency of practice and serves to increase expert nurses' frustration with the process. The complexity of assessment documentation was also seen to hinder the process of informing clinical judgement and may cloud the nurse's ability to recognise risks not specifically included in the mandated assessment tools. Implications for research, policy and practice: This discussion highlights specific elements of expert practice and compares that to contemporary assessment requirements. Further research is needed to specifically measure the time impact of current assessment requirements on nurses. Feedback from expert nurses regarding the value of current requirements and what changes would positively impact their practice and satisfaction levels is needed. This would assist in refining assessment requirements to ensure that current requirements suit nurse's practice, ensure the efficiency of expert nursing practice, maximise nursing satisfaction, and limit loss of nurses from the profession while maintaining safety of practice. What is known about the topic? • The purpose and process of patient assessment has been thoroughly investigated over time. • There is a significant body of knowledge and evidence that supports the use of standardised patient assessment documents. • The value and nature of expert nurse practice has been widely explored in existing literature. What this paper adds: • Recognition that unintended risks in contemporary assessment requirements such as duplication and complexity of data collection has the potential to reduce the efficiency of nursing practice. • Acknowledgement that assessment requirements are seen by some expert nurses as impacting safety, are burdensome and have the potential to reduce nursing satisfaction and retention. • Recognition that a disproportionate focus on assessment documentation compliance has the potential to shifts nurses' priorities away from the purpose of assessment onto the process instead. [ABSTRACT FROM AUTHOR]

Objective: To examine whether personal psychological resources safeguard hospital nurses against adverse workplace consequences, particularly job burnout and the desire to leave the profession. Background: Nursing research has extensively documented the adverse effects of job burnout and staff turnover. With the current nursing shortage, it is imperative to identify resources and strategies that can mitigate adverse workplace outcomes. However, the role of personal psychological resources, or psychological capital, in aiding nurses to perform effectively in their work environment remains relatively unexplored. Study design and methods: This study adopted a cross-sectional survey design. The survey assessed nurses' experienced burnout (MBI-HSS), psychological capital (PCQ-24), and intentions to leave nursing. Hospital nurses (n= 258) from six states of Australia responded to an online anonymous survey between June and November 2022. Results: Respondents indicated a high degree of experienced burnout: 68.6% experienced high emotional exhaustion, 31.8% had high depersonalisation, and 31.8% had low personal accomplishment. Additionally, 38.8% had high intentions to leave the profession. Emotional exhaustion (p<.001, b=.56) and personal accomplishment (p=.006, b=-.15) were significant predictors of turnover intentions. Higher psychological capital was significantly associated with lower emotional exhaustion (p<.001, b=-.42), lower depersonalisation (p<.001, b=-.29), higher personal accomplishment (p<.001, b=.60), and lower turnover intentions (p<.001, b=.44). Discussion: Much of the nursing burnout and intent to leave literature focuses on negative rather than positive aspects of the work environment. Positive responses to workplace stimuli promote positive attitudes such as empowerment, job satisfaction, and organisational commitment that have a tangible impact on personal and occupational wellbeing. This may explain why nurses with stronger personal psychological resources experienced less burnout and voiced fewer intentions to leave the profession. Conclusion: The health and wellbeing of nurses should be a priority for healthcare organisations; the working conditions nurses face in Australian hospitals cause many to be negatively impacted by work stress. Implications for Research, Policy, and Practice: Nurses would benefit from initiatives to enhance their psychological resources. Targeted interventions to develop psychological capital should be examined in a nursing population. This can change policy, thereby benefitting the healthcare system. What is already known about the topic? • Australia is currently facing a shortage of qualified nurses. • Hospital nurses often experience job burnout and high levels of turnover due to the challenging nature of their work environment. • Personal psychological resources have been linked to positive workplace outcomes, such as job satisfaction and organisational commitment, in various settings. What this paper adds: • It demonstrates that nurses possessing greater personal psychological resources experience lower levels of burnout and are less likely to consider leaving the profession. • The paper suggests that implementing targeted interventions designed to enhance nurses' personal psychological resources could be a viable approach for mitigating burnout and turnover intentions (TI). [ABSTRACT FROM AUTHOR]

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

Objective: The objective of this study is to assess and improve VTE prophylaxis practices in major abdominal surgery through a hospital audit and nurses' survey. Primary aims: Evaluate adherence to VTE prophylaxis guidelines in abdominal surgery, identify improvement opportunities in VTE prevention and assess the effectiveness of current prophylactic measures. Nurses' survey: Evaluate surgical nurses' knowledge and implementation of VTE prophylaxis and identify educational gaps to improve VTE prevention. Secondary aims: Integrate audit and survey insights: Gain insight into VTE management practices, to develop quality improvement programs for better prophylaxis and outcomes. Background: Guidelines for the prevention of venous thromboembolism (VTE) in surgical patients involve risk assessment, followed by chemical and mechanical prophylaxis. Often, VTE risk assessments are not completed which leads to inappropriate or inadequate prophylaxis. The current guidelines suggest that a healthcare provider, such as a nurse or physician, should conduct the VTE risk assessment for each patient. Study design and methods: Initially, a prospective audit was conducted to examine VTE prophylaxis practices at a tertiary hospital. This VTE audit was conducted alongside a nurses' survey to assess current VTE prophylaxis practices. Both measures were taken to review the quality of care provided to surgical patients. Results: The practice of VTE prophylaxis shows high utilisation of all three prophylactic modalities but a lack of risk assessment documentation in the medical records. Nurses, although perceiving it as their responsibility, do not conduct assessments for venous thromboembolism risk. Conclusion: Based on the audit and survey results, the hospital has not fully adopted the guidelines for venous thromboembolism prophylaxis in major abdominal surgery cases. There is a lack of proper risk assessment documentation, and nurses are not consistently engaged in conducting these. Implications for research, policy, and practice: This paper presents valuable insights into the current prescribing practices for VTE prophylaxis after major abdominal surgery, as gleaned from a clinical audit and a survey of nurses. The hospital audit indicates that overall, all three are being used, instead of two. While this approach does not contravene current guidelines, the use of both stockings and compression devices is not needed, instead adding new risks, unnecessary nursing workload and financial cost to health services. Further, this approach may prolong recovery with patients unable to mobilise while wearing compression devices to take part in rehabilitation programs. [ABSTRACT FROM AUTHOR]

Objective: This review aimed to better understand barriers to and facilitators of the professional integration of internationally qualified nurses (IQNs) in Australia. Background: Nursing shortages are a critical global issue, including developed countries such as Australia, where about 20% of the nursing workforce has been trained overseas. IQNs face many challenges associated with the migration process itself; and their professional integration is crucial in retaining them in the workforce and in maintaining the quality of nursing care in Australia. Study design and methods: This review followed the JBI methodology for mixed methods systematic review. Web of Sciences, Scopus, Informit, ProQuest, Ovid, and Cinahl databases were searched from inception. Qualitative, quantitative, and mixed methods original studies, published in English, were considered. Screening, data extraction and quality assessment were conducted independently by two reviewers. The assessment of methodological quality used the JBI Qualitative Checklist and Checklist for Analytical Cross-Sectional studies, and the data were extracted using the JBI data extraction tool. Disagreements were resolved by a third researcher and the synthesis used a convergent integrated approach. Results: From an initial 110 studies, eight studies were included. Individual and social factors emerged as the main themes. The first theme was analysed in terms of two sub-themes: psychological adaptation plus communication and language. Social factors were analysed in terms of three sub-themes: a) cultural differences in the nursing role; b) support, mentoring and appreciation and c) discrimination and racism. Discussion: psychological adaptation and language proficiency are linked to personal factors. Cultural differences in the nursing role should be addressed with strong support and mentoring programs. Recognition of previous experience and appreciation of pre-existing skills are important facilitators. Discriminatory and racist behaviours continue in the work setting, yet are rarely reported. Conclusion: Discrimination and racism from colleagues, co-workers, and patients should be addressed with a more direct approach than is currently in place. Training of locally and internationally qualified nurses in intraprofessional cultural competence may improve interaction and communication, reduce racism and discriminatory practices, and increase quality of care. Implications for research, policy, and practice: This research may be of interest to policy makers, healthcare educators, healthcare workforce planners and healthcare institutions. This study contributes to our understanding of the phenomena of nurse migration, retention, and professional integration, especially in high income countries. It is also a call to address the persistence of discriminatory and racist practices in the Australian context, as well as the education in intraprofessional cultural competence of some local nurses who work with IQNs. What is already known about the topic? • High-income countries like Australia rely on the attraction and retention of IQNs to meet their health outcomes. • Personal characteristics, language proficiency, support and mentoring programs are strong facilitators for IQNs' professional integration. • The persistence of discriminatory and racist practices are barriers to integration of IQNs in Australia. What this paper adds: • In Australia discrimination and racism continue to be dominant barriers to IQNs' professional integration. • It is crucial to improve the reporting of situations involving discrimination and racism and discuss further consequences for patients, visitors, and co-workers. • It is essential to promote training programs in intraprofessional cultural competence, and to focus on working with IQNs, as well as caring for patients from culturally and linguistically diverse (CALD) backgrounds. [ABSTRACT FROM AUTHOR]

Objective: This study aims to determine the effect of deep breathing and coughing exercise training before surgery on respiratory functions and exercise tolerance in patients with open-heart surgery in the postoperative period. Background: The decrease in respiratory functions and activity tolerance of patients after open heart surgeries reveals the need to improve this situation with effective interventions. Methods: The quasi-experimental study was conducted with 80 patients undergoing open-heart surgery. Data were collected using the patient information form and the patient follow-up form. The patients were taught deep breathing and coughing exercises before the open-heart surgery and were supported in exercising regularly before and after the surgery. The patients' respiratory functions and exercise tolerance were measured and recorded via the patient follow-up form. Results: It was determined that the respiratory capacity, distance, time, and walking speed of the patients in the experimental group during the postoperative period were significantly higher than the control group. Conclusion: Substantially, deep breathing and coughing exercise training administered before surgery to patients undergoing open heart surgery improved respiratory functions and exercise tolerance in the postoperative period. It is recommended that nurses working in open-heart surgery clinics should plan deep breathing and coughing exercise training in the preoperative period and administer them regularly to the patients. Implications for research, policy, and practice: Patients who will undergo open heart surgery should be trained by nurses in the preoperative period. Nurses should teach these patients deep breathing and coughing exercises. In the postoperative period, it should be checked regularly whether the patients do exercises or not. What is already known about the topic? • It is important to teach and practice breathing exercises in patients who will have open heart surgery. • Respiratory training given by nurses in the preoperative period contributes to the management of the postoperative process. What this paper adds: • This article demonstrates the importance of preoperative education for patients undergoing open heart surgery. • In this study, it is shown that open heart surgery has a negative effect on the respiratory capacity and exercise tolerance of the patients. • In addition, in this study, it is shown that the respiratory capacity and exercise tolerance of the patients who were taught preoperative breathing exercises and who performed the exercises in the postoperative period increased in the postoperative period. [ABSTRACT FROM AUTHOR]

Objective: To identify self-reported influences and drawbacks for early career nurses to work in a rural location. Background: The international shortage of rural nursing workforce is increasing. As a result, evidence that focuses on mechanisms to recruit early career nurses to these areas is important. This research focuses on the influences and drawbacks for early career nurses to undertake a rural graduate nursing program, aimed at providing evidence that can inform the design of rural nurse recruitment programs. Study design and methods: Manifest content analysis of open-ended questions in a cross- sectional survey that was administered in two rural Local Health Districts (LHDs) in New South Wales, Australia. Early career nurses commencing employment in either of the research locations in 2019 and 2020 were eligible to complete the survey. In two open-text questions, respondents were asked to respectively describe what the most influential factor was in their decision to commence employment in their location, and what were the drawbacks of this location, if any. Results: Of the 175 early career nurses invited to complete the survey, 165 (94.29%) returned a completed survey. Four themes were identified as influencing rural early career nurse employment; proximity to social and/or familial ties, being attracted to rural clinical practice, taking advantage of a job offer in a limited market, and wanting a rural lifestyle. Where drawbacks were described, themes referred to distance from social and/or familial ties, rural lifestyle factors, resource challenges, and a perception of less professional opportunity. Discussion: There may be an opportunity to attract and retain rural nurses through targeted social initiatives and creating community ties, particularly among those early career nurses who have no close friends and family nearby. This reflects other literature and the growing understanding of the importance of social connection, familial ties and life course in early career nurse decision making. Conclusion: The results of this research demonstrate that proximity to social and/or familial ties is both the biggest influence and drawback for early career nurses to accept employment in a rural location. Implications for research, policy, and practice: Strategies that capitalise on practical ways to integrate social connection and life course approaches in early career nurse onboarding in rural areas should be explored in future research with a view to creating guidance for rural health organisations and policy makers. What is already known about the topic? • Australia is facing a significant and growing deficit in the number of nurses choosing to practice rurally. • Rural origin and rural placements influence rural practice intention. • Early career nurse programs are an initiative aimed to support the transition of nurses into practice from undergraduate study and can act as a pathway for nurses to enter rural careers. What this paper adds: • Family and social ties are the most influential reasons for choosing a rural location for early career nurses. • Commensurate with this is the greatest drawback for choosing a rural location for early career employment was being away from family and/or friends. • Future research should explore practical strategies that capitalise on the importance of social connections, familial ties, and life course for rural nurse career decisions. [ABSTRACT FROM AUTHOR]

Objective: To present and discuss options for upskilling registered nurse supervisors to ultimately improve the quality and consistency of nursing student placements. Background: Many studies have examined clinical learning in nursing, with evidence that student learning and registered nurse clinical supervision experiences can be improved. An independent review of nursing education in Australia confirmed gaps in the preparation and support of supervising registered nurses that may negatively impact students' learning. Study design and methods: This paper discusses contemporary insights around 1) the current situation in Australian nursing student clinical placements regarding learning, 2) registered nurse clinical supervisor experiences and 3) professional options for recognising role excellence, offered by Australian and international nursing and healthcare specialities. Discussion: Nursing students' placement experiences are at times sub-optimal. One way to improve learning experiences could be to offer clinical supervisors professional development programs. Now is the time to consider a certification process to recognise excellence in registered nurses' education capabilities and to better support students' clinical learning. Conclusion: Upskilling registered nurses for clinical supervision may be assisted through formal and informal education programs specific to the professional nursing context in Australia. Implications for research policy and practice: Upskilling registered nurse clinical supervisors should be a priority on the national agenda of improving students' clinical learning experiences. This commentary provides contemporary insights to the current situation regarding Australian students' clinical placement and supervisor experiences. The ways that some nursing specialities recognise excellence in practice are discussed as options for improving clinical supervision. What is already known about the topic * Nursing students' clinical placements need improvement; students continue to report less than optimal experiences. * There are no requirements in Australia for registered nurse clinical supervisors to undertake assessment of capability for the role. * National and international processes exist to recognise supervisor capabilities and role excellence. What this paper adds * Options for recognising capability and practice excellence in nursing clinical supervision. * A discussion around clinical supervisors engaging with formal and informal education and processes that recognise excellence in role capabilities. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has had widespread impacts on the community and has demanded a rapid response from the aged care sector. System changes for infection control have been required including the use of personal protective equipment, lockdowns, visitor restrictions and changes to activities within aged care facilities. Even prior to COVID-19, the high physical and emotional demands of aged care work were recognised. Objective: This study sought to understand aged care workers' experiences of the COVID-19 pandemic. Methods: Using a pragmatic paradigm qualitative data about work experiences during COVID-19 was collected from people employed in different aged care organisations in a range of aged care roles and settings from multiple Australian states. Data was collected using focus groups and interviews conducted online between August-October 2020. Inductive thematic analysis was used to identify key themes in the data. results: Participants included 15 people working across a range of aged care roles including clinical, care and management staff and across both residential and community settings. Five themes were identified which characterised aged care workers thoughts about their jobs during the pandemic. These included intensified procedures and emotional demands, feeling undervalued and detached from the frontline, exposure of existing system deficiencies, recognising teamwork and increased confidence in technology. conclusion: Reflecting on aged care workers' experiences of COVID-19 highlights the need to better support workers and acknowledge their important role in caring for older Australians. This includes at an organisational level by providing supportive environments and access to online resources as well as at the community and policy level by recognising aged care workers as frontline workers. The COVID-19 pandemic has also highlighted existing systemic issues in the aged care sector that need to be addressed for the provision of quality aged care in Australia during the COVID-19 pandemic and into the future. What is already known about the topic? * While the COVID-19 pandemic is affecting the global community, it is disproportionately impacting the aged care sector with higher rates of severe illness and death and wide-ranging system changes to prevent and control the spread of the virus. * Prior to COVID-19, aged care work was associated with high job demands and lack of access to resources to support aged care workers in their role. * Survey data on the Australian RACF workforce found workers felt prepared for the pandemic with a wide range of measures to control the spread of COVID-19 but they faced several challenges associated with their additional roles and restrictions. What this paper adds * This paper provides qualitative and descriptive insights into the challenges experienced by the Australian aged care workforce during COVID-19 including increased workloads and intensified emotional demands of their roles while at the same time feeling undervalued by the wider community. * This study has highlighted the need to better support and acknowledge aged care workers in the community through their portrayal in the media and within their organisations by facilitating supportive team environments and providing access to online resources and training. * This paper discusses existing systemic issues that have been highlighted by COVID-19 and the Royal Commission into Aged Care Quality and Safety and need to be addressed for the wellbeing of workers and the provision of quality aged care. [ABSTRACT FROM AUTHOR]

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

Objective: To examine the validity of the Edinburgh Postnatal Depression Scale (EPDS) for screening depression in pregnant and postpartum adolescents. Background: The incidence of postpartum depression (PPD) in 15 to 19-year olds is double the rate reported among mothers older than 25 years. EPDS threshold scores that indicate possible depression among adolescents have not been established and may differ from those validated for adults. Study design and methods: A systematic review of the literature between 1987 and 2020 was conducted using five databases: CINAHL, EMBASE, MEDLINE, MIDIRS and PsycInfo. Studies that sampled adolescent mothers in the perinatal period, that screened for depressive symptoms using the EPDS, and which assessed the validity of the tool were included. The studies were grouped according to their methodology with results presented as a narrative synthesis. Two researchers independently reviewed search results, study selection and data extraction, and undertook quality appraisals using the Quality Assessment of Diagnostic Accuracy Studies checklist. Results: Five studies that sampled a total of 1,241 participants were included in the review: four validated the EPDS against diagnostic reference standards and one against other depression screening tools. The EPDS demonstrated high levels of sensitivity and specificity although optimal cut-off scores for possible depression were between 2 and 7 points lower than that recommended for adult samples. Overall performance of the EPDS was equivalent or better when compared to other screening tools. Discussion: The standard EPDS cut-off score (>12) does not identify all adolescents at high risk of depression during the perinatal period. Scores of >9 may be more appropriate. However, different reference standards and sampling methods used in the studies compromise the review's strength of evidence. Conclusion: Despite development of the EPDS more than 30 years ago, research into its validity among adolescents is still in its infancy. This review makes an important contribution to that body of evidence by revealing its limitations and highlighting trends upon which further research can build. Implications for research, policy and practice: Although Australian guidelines for perinatal depression screening are some of the most detailed in the world, limited guidance is offered for EPDS use among adolescents. The findings of this review raise important points for that guidance and for practitioners. Concerns for possible depression in adolescents should be triggered at an advisory EPDS cut-off score of ≥9. Further research is needed to confirm or refute these findings. What is already known about the topic? * Postpartum depression (PPD) among adolescents is prevalent and a recognised public health concern due to its significant association with morbidity. * Perinatal screening for depression using validated instruments, including the Edinburgh Postnatal Depression Scale (EPDS), is recommended in national and international guidance. * There is no validated version of the EPDS for adolescents although there is evidence to suggest that cut-off scores indicative of possible depression may need to be lower than those recommended for adults. What this paper adds: * The paper synthesises evidence that demonstrates the EPDS is a valid scale for perinatal screening of depression in adolescents. * It identifies lower cut-off scores for suspected depression among adolescents compared to adults, and also highlights score differences in the pre and postnatal periods. * The paper provides advisory screening guidance for practitioners and emphasises the importance of monitoring for depressive symptoms in perinatal adolescents at every healthcare encounter. [ABSTRACT FROM AUTHOR]

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

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

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

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

Objective: This scholarly paper aims to discuss the importance of reflective practice in nursing, both theoretically and clinically, for undergraduate and graduate nurses. The article also aims to provide direction by comparing and contrasting four reflective models to provide a basis for self-reflection. Primary argument: The Nursing and Midwifery Board of Australia requires nurses to be reflective practitioners. Gaining greater knowledge of different models of reflection may aid nurses, both undergraduate and graduate, to enhance their clinical and theoretical knowledge through reflection in their day-to-day practice. Registered nurses may develop their practice through reflecting on their actions, experiences, knowledge, feelings and beliefs to shape their ongoing education and practice. Conclusion: There is an expectation from registering authorities for nurses to be reflective practitioners. This paper provides information on four different models of reflection, discussed in a systematic and logical order, with a view to highlighting the value of their use to support reflective practice. A comparative framework is provided to highlight similarities and differences. A personal reflection, based on a real-life event, using one of the models is included to provide an authentic example. [ABSTRACT FROM AUTHOR]

Objective: We conducted a survey to understand the challenges faced by the staff of residential aged care facilities (RACF), during the COVID-19 pandemic. Background: In the current pandemic, the RACF workforce has been required to work under stressful conditions, with immense mental and physical pressures, resulting in anxiety and stress felt towards their jobs. Study design and methods: We electronically surveyed both clinical and non-clinical staff at public and private RACFs in Australia in June and August 2020. The survey asked a mix of openended and closed questions about preparedness for the pandemic, information flow, experience with personal protective equipment (PPE), management of suspected COVID cases, restrictions on visitors, and impact on RACF staff personal and home life. Quantitative data were analysed in SPSS; qualitative data using content analysis. Results: We received 371 responses: 198 from clinical staff and 168 from non-clinical staff. Respondents were between 20--71 years old, and 87% were female most commonly from Victoria (28%) or New South Wales (28%). The majority (80%) felt that Australian RACFs were well-prepared for the pandemic and 87% agreed that relevant healthcare authorities were contactable for information needed. A total of 37% reported challenges in estimating and ordering appropriate quantities of protective equipment. Ninety percent of facilities reported screening residents for possible symptoms and 77% introduced precautions or quarantine measures to protect residents. Most participants (98%) reported their RACF implemented restrictions on visitor access and 43% reported unfair or abusive treatment by family or friends of the residents. Commonly reported personal impacts included: workload increase, stress, emotional toll, family issues and fatigue. Support from colleagues as well as training, de-brief sessions and frequent meetings were identified as helpful facilitators during this time. Conclusion: We identified a wide range of practices and coping strategies among Australian RACFs. Whilst a majority of respondents reported coping well, a large proportion reported struggling both mentally and physically. Factors reported as helpful by the respondents may assist RACFs in planning for future pandemics. Implications for research, policy and practice: Understanding the challenges faced by all levels of staff within RACFs may aid decision-makers on a range of different levels -- researchers, aged care providers, local/regional/state health departments and national leaders within government to help inform the development of interventions that may help the sector to recover, as well as prepare for potential future outbreaks. Of particular importance, are interventions or initiatives that focus on supporting the physical and mental health of staff i.e. those that prevent or minimise worker fatigue, emotional burnout and stress. What is already known about the topic? • Nursing staff in Australian RACFs did not feel prepared for the COVID outbreak in their workplace. • Early in 2020, RACF nurses experienced a greater overall workload and some had their staff hours reduced by their employers due to financial constraints caused by the outbreak. What this paper adds • This paper offers a comprehensive insight into how RACF staff coped both individually and as part of the facility overall during the COVID crisis. • It identified that a commonly reported source of stress was first-hand verbal abuse from family or friends of residents in response to visitor and lockdown restrictions implemented by the authorities. • The paper highlighted that whilst the majority of respondents felt that RACFs were well prepared for managing residents during the pandemic, some facilities experienced significant problems with workloads, PPE and human resourcing. • Furthermore, the survey showed that on an individual level, some staff experienced significant mental and physical stress during the outbreak. [ABSTRACT FROM AUTHOR]

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

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

Objective: To investigate third-year undergraduate nursing students' perceptions and views on being prepared for using patient electronic medical records (EMR) in clinical placement after using only paper-based documentation during their education program; and their opinion on the introduction of EMR in the university simulated learning environments to be work ready. Background: Contemporaneous clinical practice in many countries now requires nurses to competently use patient EMR including electronic observation and medication charts. However, Australia has been slow in introducing this learning into undergraduate nursing programs. For this reason, there is a knowledge gap examining nursing students' viewpoints on learning EMR in their undergraduate program in preparation for the clinical environment and future registered nurses in Australia. Methods: All third-year students enrolled in the undergraduate nursing program at one regional metropolitan university in New South Wales (including three campuses) were invited to complete an electronic questionnaire. This survey included questions on the students' perceptions on their confidence and preparedness using EMR in clinical practice based on their current paper-based learning in the university simulation laboratories; and their opinions on the benefits of integrating EMR learning into the undergraduate nursing curriculum. Results: Seventy third-year nursing students completed the questionnaire, a response rate of 13.2%. Most respondents (71.1%) did not feel prepared to use EMR in the clinical setting after only learning paper-based documentation and 81.7% did not feel confident accessing patients EMR the first time. Nearly all students (98.5%) believed they would be more confident using EMR initially in their clinical placements if there had been opportunity to practice using EMR in the university simulation laboratories. There was a significant difference with female participants perceived improved confidence accessing patients EMR, if EMR was integrated into the university simulated laboratories compared to the male participants (p=0.007). Conclusion: In this study, third year nursing students believed that learning to use an EMR program in the university simulated environment will increase their confidence and preparedness when on clinical placement and be work ready as registered nurses. Implications for research, policy and practice: This study showcases the importance of preparing nursing students for entering the workforce as confident and competent new graduate registered nurses and integrating health informatics and digital health technologies universities in undergraduate nursing programs in Australia. Future studies on Australian student's experience with the introduction of an academic EMR program is recommended. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to report on the experience of racial discrimination by black sub-Saharan overseas qualified nurses working in rural Australia. Background: The arrival of black African people as skilled professional migrants is relatively new in rural Australia. The presence of black sub-Saharan African nurses in Australian healthcare facilities is changing the face of the Australian nurse. Australia, like other developed countries, has been receiving migrant nurses from the African continent in a bid to reverse its critical nurse shortage. Literature has shown that globally, overseas qualified nurses of colour have encountered work challenges that have included racial discrimination. Study design and methods: A qualitative hermeneutical phenomenological approach was used. Eighteen nurses were purposively selected using personal invite and a snowballing technique. Data collection involved individual face to face interviews and a focus group discussion. Results: The exploration of experiences revealed issues of race and colour among colleagues and between patients and overseas qualified nurses. Overseas qualified nurses experienced incidents of Objective: The aim of this paper is to report on the experience of racial discrimination by black sub-Saharan overseas qualified nurses working in rural Australia. Background: The arrival of black African people as skilled professional migrants is relatively new in rural Australia. The presence of black sub-Saharan African nurses in Australian healthcare facilities is changing the face of the Australian nurse. Australia, like other developed countries, has been receiving migrant nurses from the African continent in a bid to reverse its critical nurse shortage. Literature has shown that globally, overseas qualified nurses of colour have encountered work challenges that have included racial discrimination. Study design and methods: A qualitative hermeneutical phenomenological approach was used. Eighteen nurses were purposively selected using personal invite and a snowballing technique. Data collection involved individual face to face interviews and a focus group discussion. Results: The exploration of experiences revealed issues of race and colour among colleagues and between patients and overseas qualified nurses. Overseas qualified nurses experienced incidents of Nurse managers need to be more vigilant in monitoring staff interactions in their Units. Understanding and support for diversity at the workplace by all nurses will improve patient and staff safety. [ABSTRACT FROM AUTHOR]

Objective: The aim of the evidence implementation initiative was to improve the quality of care delivered to hospitalised patients at risk of, or with, delirium through the implementation of best practice recommendations. Background: Delirium is a prevalent serious medical condition that remains unrecognised or misdiagnosed in acute hospitals and is therefore left untreated. This paper reports on a hospital-wide quality improvement project which was undertaken in recognition of the Australian Delirium Clinical Care Standard and as a response to the cumulative rate of hospital-acquired delirium within a health organisation in New South Wales, Australia. Methods: The quality improvement project used the JBI (formerly known as Joanna Briggs Institute) evidence implementation framework. Briefly, the JBI evidence implementation approach is grounded in the audit, feedback and re-audit process along with a structured process for the identification and management of barriers to compliance with recommended clinical practices. Twelve nurses, who received support from external facilitators (implementation researchers), acted as delirium champions. Results: Baseline audit of 143 patient notes showed poor compliance (range 6% -- 67%) to recommended practices relating to screening, assessment, prevention and management of delirium. Barriers analysis revealed nurse-related (eg. lack of knowledge) and organisational level factors (e.g. absence of a hospital-wide policy/procedure for delirium management). A multicomponent strategy was implemented by all delirium champions in their respective units/wards. Follow-up audit of 151 patient notes demonstrated significant improvements in compliance with best practice recommendations for all aspects of delirium care. Discussion: The quality improvement activity highlighted that education remains one of the most important and critical first steps in facilitating change in clinical practice. Critical to the success of the project was the collaborative approach of the delirium champions across various specialties, which allowed for the sharing of expertise, knowledge and consensus-based decision making. The facilitation provided by the delirium champions and external facilitators was also a vital ingredient for the successful implementation of evidence-based practices. Conclusion: The quality improvement activity has improved nurses' screening and assessment of patients at risk of or with delirium, leading to improvements in its prevention and management. Collaborative efforts within the organisation facilitated the development of a standardised, evidence-based tool for delirium screening, assessment, prevention and management, and staff education resources. Partnership with patients and/or their families through education remains an area for ongoing improvement, as with discharge planning for patients with current or resolved delirium. What is already known about the topic? • Delirium care is a major challenge among healthcare practitioners and therefore the condition remains prevalent in many acute hospitals. In Australia, delirium has been identified as a high priority area for quality improvement. The Australian Commission on Safety and Quality in Health Care released the Delirium Clinical Care Standard to ensure that patients at risk of delirium are identified early and receive preventative strategies, and that those with delirium receive optimal treatment to address their condition. What this paper adds: • This paper offers a detailed approach for evidence implementation to improve the quality of care delivered to hospitalised patients at risk of or with delirium. Key enablers were strong leadership support, sharing of experiences and knowledge, and the collective effort to problem solve and develop tools and resources for delirium. [ABSTRACT FROM AUTHOR]