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Background: Strict patient isolation in hospital is associated with adverse health outcomes. However, there is a lack of high‐quality evidence for effective interventions to improve safety and quality of care for these patients. Aims: To identify patient reported areas for improvement in the care of patients in hospital isolation and to determine the feasibility of collecting patient reported outcomes using validated tools. Methods: Design: An exploratory mixed methods study. Setting: A major metropolitan teaching hospital in Melbourne, Australia. Participants: Patients in hospital isolation for transmissible infections. Data collection: Data were collected by (1) phone interviews with patients in isolation and (2) seven validated measurement tools to assess cognition, loneliness, nutritional status, quality of life, anxiety and depression and physical activity. Data were collected between September and December 2021. Data analysis: Interviews were transcribed and analysed using thematic analysis. Quantitative data were analysed descriptively including participant characteristics and outcome data. Results: Participants identified areas for improvement including activities to decrease boredom, more contact with staff to mitigate loneliness and increase comfort care, and formalised communication about clinical treatment and discharge plan. Patients with gastrointestinal symptoms were happier to be alone. There were operational challenges within the health service including delays and miscommunication. Only 70% of the participants completed all questionnaires. Conclusion: This study identified areas for improvement in care of patients in isolation and demonstrated that collecting patient reported outcomes using validated tools was feasible. The results of this research will inform development of an intervention to manage adverse effects. Implications for the Profession and/or Patient Care: Patients in hospital isolation require additional consideration to ensure that their needs are met to avoid adverse outcomes. The patient experience and comfort can be negatively affected when fundamental care is lacking. Reporting Method (EQUATOR): EQUATOR guidelines for Mixed Methods Reporting in Rehabilitation & Health Sciences (MMR‐RHS). Patient or Public Contribution: Thirteen patients in hospital isolation agreed to participate in this study, sharing their experiences through interviews and assessment. [ABSTRACT FROM AUTHOR]

Aims and objectives: To develop a communication app to support nursing staff during the provision of standard care of patients from non‐English‐speaking backgrounds (NESBs), when an interpreter is not available. This paper reports on the user needs analysis phase that informed the development, content and functionality of the app. Background: In 2014 we developed CALD Assist, a communication app to support patient interactions with allied health clinicians when interpreters are not present. It includes 95 commonly used phrases professionally interpreted into 10 languages and grouped by discipline. This work expands upon our previous app to meet the needs of the nursing workforce. Design: Qualitative through focus groups, observations and interviews, with a quantitative component from observational data and staff surveys. Methods: Four focus groups with hospital staff, ten interviews with patients from NESBs and 85 observation sessions of everyday patient–staff interactions followed by staff surveys (n = 85) were held between January and June 2017. Results: Baseline data prior to app development revealed that staff confidence of the patients’ level of understanding and the success of the interaction were significantly greater for English‐speaking (ES) patients, than for non‐English‐speaking patients. A total of 143 phrases were identified and subdivided into 16 categories for inclusion in the new app. Conclusion: Staff participants highlighted that patients from NESBs are a challenging patient group to interact with. Patient and staff participants identified a range of areas where the nursing app could benefit, including pain management, mobility, hygiene and nutrition. Relevance to clinical practice: The proposed app can be used to reduce variances in practice and provide a timely and positive patient experience for patients from NESBs who are unable to communicate in English during hospital admissions. [ABSTRACT FROM AUTHOR]

Aim To describe the design, development and evaluation of a consumer-centred video, which was underpinned by the Theory of Planned Behaviour and it was created to educate newly transplanted kidney recipients about the importance of medication adherence. Background Kidney transplantation is a treatment whereby medication adherence is critical to ensure long-term kidney graft success. To date, many interventions aimed to improve medication adherence in kidney transplantation have been conducted but consumers remain largely uninvolved in the interventional design. Design Qualitative sequential design. Methods Twenty-two participants who had maintained their kidney transplant for at least 8 months and three participants who had experienced a kidney graft loss due to non-adherence were interviewed from March-May 2014 in Victoria, Australia. These interviews were independently reviewed by two researchers and were used to guide the design of the story plot and to identify storytellers for the video. The first draft of the video was evaluated by a panel of seven experts in the field, one independent educational expert and two consumers using Lynn's content validity questionnaire. The content of the video was regarded as highly relevant and comprehensive, which achieved a score of >3·7 out of a possible 4. Results/findings The final 18-minute video comprised 15 sections. Topics included medication management, the factors affecting medication adherence and the absolute necessity of adherence to immunosuppressive medications for graft survival. Conclusion This paper has demonstrated the feasibility of creating a consumer-driven video that supports medication adherence in an engaging way. [ABSTRACT FROM AUTHOR]

Evidence-based practice ( EBP) in the clinical setting is recognized as an approach that leads to improved patient outcomes. Nurse educators ( NEs), clinical coaches ( CCs) and nurse specialists are in key positions to promote and facilitate EBP within clinical settings and have opportunities to advance practice. Therefore, it is important to understand their perceptions of factors promoting EBP and perceived barriers in facilitating EBP in clinical settings, before developing educational programmes. This paper reports findings from a study that aimed to explore NEs' , CCs' and nurse specialists' knowledge, skills and attitudes associated with EBP. This study used a questionnaire containing quantitative and a small number of qualitative questions to capture data collected from NEs, CCs and nurse specialists working at a tertiary health-care facility in Victoria, Australia. The questionnaire was distributed to a total of 435 people, of whom 135 responded (31%). Findings revealed that the three senior nurse groups relied heavily on personal experience, organizational policies and protocols as formal sources of knowledge. Furthermore, they had positive attitudes towards EBP. However, participants demonstrated lack of knowledge and skills in appraising and utilizing evidence into practice. They indicated a desire to seek educational opportunities to upskill themselves in the process of EBP. [ABSTRACT FROM AUTHOR]

Background: As frontline healthcare workers, there is a growing expectation that nurses should be able to respond to disclosures of family violence. However, the profession and hospital systems have been slow to respond with clear skills, knowledge and confidence deficits identified in existing research. There is limited research which has robustly evaluated the effectiveness of in‐depth, multifaceted training on readiness to respond among nurses. Aim: To longitudinally evaluate the effectiveness of an in‐depth family violence training intervention on confidence, knowledge and clinical skills of nurses working in a large tertiary adult hospital. Design: Single‐centre, longitudinal intervention study. Strengthening the Reporting of Observational studies in Epidemiology (STROBE) cross‐sectional guidelines were used. Methods: One hundred and ten nursing clinicians participated in this study to complete a comprehensive evidence‐based model of healthcare workers response for assisting patients experiencing family violence. A mixed methods survey was used to assess change in knowledge, confidence and clinical skills among participants. Outcome assessment was electronically undertaken at baseline, 6–9 months and 12–15 months following intervention. Results: Statistically significant improvement was seen in self‐reported knowledge, confidence and frequency of screening for family violence. Relative to baseline estimates, these improvements were identified 6–9 months and 12–15 months following intervention; albeit with consideration to the visually observed trend of skill reversion at follow‐up. Quantitative findings were paralleled by qualitatively identified improvements in the recognition of the intersectional nature of violence, need for patient collaboration in screening and depth in considerations around how family violence is screened for. Conclusions: Findings provide tentative support for the utility of a multidimensional training approach to improving nurses' readiness to respond to disclosures of family violence. Relevance to clinical practice: This study provides preliminary support for multidimensional, evidence‐based training to effectively improve nurses' confidence, knowledge and clinical skills required for responding to family violence. Reporting Method: The study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (SQUIRE) Statement: guidelines for reporting observational studies (see Table S1). Patient Contribution: Patients were involved in the initial design of the survey tool. This involvement came through the Allied Health Consumer panel and included input on the design and question wording of the survey items. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore service provision for Victorian regional refugee families from the perspective of maternal and child health nurses. Background: Increasingly, more families from a refugee background are resettling in regional Victoria. The refugee journey has significant effect on families. Refugee families with infants and young children can be provided with support by maternal and child health services; however, many families experience barriers to ongoing engagement with this service. Design: This descriptive study used focus group and questionnaire. A purposive sample of 26 maternal and child health nurses was drawn from six municipalities throughout regional Victoria, where higher numbers of people from a refugee background resettle. Six focus groups were held in 2014. Audio‐recorded narratives were transcribed, prior to inductive thematic analysis. Methods: This descriptive study used focus group and questionnaire. A purposive sample of 26 Maternal and Child Health nurses was drawn from six municipalities throughout regional Victoria where higher numbers of people from a refugee background resettle. Six focus groups were held in 2014. Audio‐recorded narratives were transcribed verbatim, prior to inductive thematic analysis. Results: Participating nurses were experienced nurses, averaging 12 years in the service. Four major themes emerged from thematic analysis: “How to identify women from a refugee background”; “The Maternal and Child Health nurse role when working with families from a refugee background”; “Interpreting issues”; and “Access to other referral agencies.” Nurses worked to develop a relationship with families, attending to a complex mix of issues which were complicated by language barriers. Nurses found their role in supporting refugee families required additional time and more home visits. Conclusions: To provide best practice, maternal and child health nurses need (i) ongoing professional development; (ii) time, flexibility and creativity to build relationships with refugee families and (iii) better access to services that enhance communication, such as interpreting services and translated resources. Relevance to clinical practice: Nurses require ongoing professional development to help them address the multifaceted needs of families of refugee background. With limited resources available in regional areas, accessing further education can be challenging. Distance education models and organisational support could provide nurses with educational opportunities aimed at improving service provision and clinical practice. [ABSTRACT FROM AUTHOR]

Aims and objectives: To obtain an understanding of how Hospital in the Home (HITH) nurses recognise and respond to clinical deterioration in patients receiving care at home or in their usual place of residence. Background: Recognising and responding to clinical deterioration is an international safety priority and a key nursing responsibility. Despite an increase in care delivery in home environments, how HITH nurses recognise and respond to clinical deterioration is not yet fully understood. Design: A prospective, descriptive exploratory design was used. A survey containing questions related to participant characteristics and 10 patient scenarios was used to collect data from 47 nurses employed in the HITH units of three major health services in Melbourne, Australia. The 10 scenarios reflected typical HITH patients and included medical history and clinical assessment findings (respiratory rate, oxygen saturation, heart rate, blood pressure, temperature, conscious state and pain score). Results: The three major findings from this study were that: (i) nurse and patient characteristics influenced HITH nurses’ assessment decisions; (ii) the cues used by HITH nurses to recognise clinical deterioration varied according to the clinical context; and (iii) although HITH nurses work in an autonomous role, they engage in collaborative practice when responding to clinical deterioration. Conclusion: Hospital in the Home nurses play a fundamental role in patient assessment, and the context in which they recognise and respond to deterioration is markedly different to that of hospital nurses. Relevance to clinical practice: The assessment, measurement and interpretation of clinical data are a nursing responsibility that is crucial to early recognition and response to clinical deterioration. The capacity of HITH services to care for increasing numbers of patients in their home environment, and to promptly recognise and respond to clinical deterioration should it occur, is fundamental to safety within the healthcare system. Hospital in the Home nurses are integral to a sustainable healthcare system that is responsive to dynamic changes in public health policies, and meets the healthcare needs of the community. [ABSTRACT FROM AUTHOR]

Aims and objectives (1) To explore graduate nurses' perceptions of the influence of multisource feedback on their performance and (2) to explore perceptions of Clinical Nurse Educators involved in providing feedback regarding feasibility and benefit of the approach. Background Graduate registered nurses are expected to provide high-quality care for patients in demanding and unpredictable clinical environments. Receiving feedback is essential to their development. Performance appraisals are a common method used to provide feedback and typically involve a single source of feedback. Alternatively, multisource feedback allows the learner to gain insight into performance from a variety of perspectives. This study explores multisource feedback in an Australian setting within the graduate nurse context. Design Multimethod study. Methods Eleven graduates were given structured performance feedback from four raters: Nurse Unit Manager, Clinical Nurse Educator, preceptor and a self-appraisal. Thirteen graduates received standard single-rater appraisals. Data regarding perceptions of feedback for both groups were obtained using a questionnaire. Semistructured interviews were conducted with nurses who received multisource feedback and the educators. Results In total, 94% (n = 15) of survey respondents perceived feedback was important during the graduate year. Four themes emerged from interviews: informal feedback, appropriateness of raters, elements of delivery and creating an appraisal process that is 'more real'. Multisource feedback was perceived as more beneficial compared to single-rater feedback. Educators saw value in multisource feedback; however, perceived barriers were engaging raters and collating feedback. Conclusions Some evidence exists to indicate that feedback from multiple sources is valued by graduates. Further research in a larger sample and with more experienced nurses is required. Relevance to clinical practice Evidence resulting from this study indicates that multisource feedback is valued by both graduates and educators and informs graduates' development and transition into the role. Thus, a multisource approach to feedback for graduate nurses should be considered. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the factors emergency nurses use to inform their decisions regarding frequency and nature of vital sign assessment. Background Research related to clinical deterioration and vital sign assessment in the emergency department is in its infancy. Studies to date have explored the frequency of vital sign assessment in the emergency department; however, there are no published studies that have examined factors that emergency nurses use to inform their decisions regarding frequency and nature of ongoing vital sign assessment. Design A prospective exploratory design was used. Data were collected using a survey consisting of eight patient vignettes. Methods The study was conducted in one emergency department in metropolitan Melbourne. Participants were emergency nurses permanently employed at the study site. Results A 96% response rate was achieved ( n = 47/49). The most common frequency of patient reassessment nominated by participants was 15 or 30 minutely, with an equal number of participants choosing these frequency intervals. Abnormality in initial vital sign parameters was the most common factor identified for choosing either a 15- or 30-minute assessment interval. Frequency of assessment decisions was influenced by years of emergency nursing experience in one vignette and level of postgraduate qualification in three vignettes. Heart rate, respiratory rate and blood pressure were all nominated by over 80% of participants as vital signs that participants considered important for reassessment. The frequency and nature of vital signs selected varied according to vignette content. There were significant negative correlations between assessment of conscious state and years of nursing experience and assessment of respiratory rate and years of emergency nursing experience. Level of postgraduate qualification did not influence selection of parameters for reassessment. Conclusion Emergency nurses are tailoring vital sign assessment to patients' clinical status, and nurses are integrating known vital sign data into vital sign decision-making. Relevance to clinical practice Accurate assessment and interpretation of vital sign data is fundamental to patient safety. Emergency nurses are responsible for the initial and ongoing assessment of undiagnosed or undifferentiated patients. Prior to medical assessment, emergency nurses are solely responsible for patient assessment, escalation of care and implementation of interventions within nursing scope of practice. [ABSTRACT FROM AUTHOR]

Aims and objectives Pelvic organ prolapse is a common condition, with reported incidence of up to 50%. We aimed to assess whether written information, in addition to face-to-face consultation, improved happiness with information, confidence to self-manage and prolapse knowledge in women attending a pessary clinic. Background Little is known about the effect of adding a written information brochure on clinical outcomes of patients using pessaries. Design This prospective study used a pretest-posttest method, conducted following Ethical approval. Methods Between February-December 2013, all women attending Pessary Clinic were eligible for participation. A questionnaire was developed to assess happiness with information, confidence regarding self-management (using a visual analogue scale, 1-10) and prolapse knowledge (using eight multiple-choice questions). Data were collected in person at baseline prior to distribution of a patient brochure and thereafter by telephone at one week and three months. Paired analysis was conducted using the McNemar test and related samples Wilcoxon signed-rank test for VAS items with p < 0.05 significant. Results Sixty women were recruited. Fifty-eight completed all questionnaires. Improvement in happiness with information, confidence regarding self-management and knowledge scores occurred at one week ( p < 0.05) and were maintained at three months ( p < 0.05). Changes were unrelated to age ( p > 0.05), education level ( p > 0.05), first language ( p > 0.05) or previous clinic visits ( p > 0.05). Conclusion A written information brochure, in addition to face-to-face consultation, improves happiness with information, confidence to self-manage and knowledge about pessaries compared to verbal instruction alone and helps patients better understand their care. The written brochure was equally effective in women with low education and advanced age, and occurred regardless of the number of clinic visits. [ABSTRACT FROM AUTHOR]

Aim To investigate factors contributing to the sustained domestic violence screening and support practices of Maternal and Child Health nurses 2 years after a randomized controlled trial. Background Domestic violence screening by healthcare professionals has been implemented in many primary care settings. Barriers to screening exist and screening rates remain low. Evidence for longer term integration of nurse screening is minimal. Trial outcomes showed sustained safety planning behaviours by intervention group nurses. Design Process evaluation in 2-year follow-up of a cluster randomized controlled trial. Methods Evaluation included a repeat online nurse survey and 14 interviews (July-September 2013). Survey analysis included comparison of proportionate group difference between arms and between trial baseline and 2 year follow-up surveys. Framework analysis was used to assess qualitative data. Normalization Process Theory informed evaluation design and interpretation of results. Results Survey response was 77% ( n = 123/160). Sustainability of nurse identification of domestic violence appeared to be due to greater nurse discussion and domestic violence disclosure by women, facilitated by use of a maternal health and well-being checklist. Over time, intervention group nurses used the maternal checklist more at specific maternal health visits and found the checklist the most helpful resource assisting their domestic violence work. Nurses' spoke of a degree of 'normalization' to domestic violence screening that will need constant investment to maintain. Conclusion Sustainable domestic violence screening and support outcomes can be achieved in an environment of comprehensive, nurse designed and theory driven implementation. Continuing training, discussion and monitoring of domestic violence work is needed to retain sustainable practices. [ABSTRACT FROM AUTHOR]

Aim To investigate characteristics of collaboration between nurse practitioners and medical practitioners in the primary healthcare setting in Australia. Background Recent definitions of collaboration in the literature describe it as being based on communication, shared decision-making and the respect and equality of team members. However, research demonstrates a tension between this theoretical ideal and how collaboration between nurse practitioners and medical practitioners occurs in practice. Different socialization processes of the two professions and legislative requirements influence collaborative practice. The way these two professions overcome traditional boundaries and realize collaborative practice in the primary healthcare setting needs to be examined. Design Mixed methods multiple case study including up to six sites with a minimum of six and a maximum of 20 participants in total. Methods Data on collaborative practice between nurse practitioners and medical practitioners in primary health care will be collected in three phases: (1) two-week direct observation in the practice setting to capture actual behaviour and context; (2) questionnaire to measure dimensions of collaboration; and (3) one-to-one semi-structured interviews with nurse practitioners, medical practitioners and practice managers to record experiences, perceptions and understanding of collaboration. Discussion Triangulation of findings will generate a comprehensive understanding of how collaboration between nurse practitioners and medical practitioners in Australia occurs in the primary care setting. The results of this study will inform nurse practitioners, medical practitioners practice managers and policy makers on successful models of collaboration. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine the psychometric properties of the Handover Evaluation Scale using exploratory and confirmatory factor analysis. Background Handover is a fundamental component of clinical practice and is essential to ensure safe patient care. Research indicates a number of problems with this process, with high variability in the type of information provided. Despite the reported deficits with handover practices internationally, guidelines and standardised tools for its conduct and evaluation are scarce. Further work is required to develop an instrument that measures the effectiveness of handover in a valid and reliable way. Design Secondary analysis of data collected between 2006-2008 from nurses working on 24 wards across a large Australian healthcare service. Methods A sample of 299 nurses completed the survey that included 20 self-report items which evaluated the effectiveness of handover. Data were analysed using exploratory factor analysis and confirmatory factor analysis supported by structural equation modelling. Results Analyses resulted in a 14-item Handover Evaluation Scale with three subscales: (1) quality of information (six items), (2) interaction and support (five items) and (3) efficiency (three items). A fourth subscale, patient involvement (three items), was removed from the scale as it was not a good measure of handover. Conclusions The scale is a self-report, valid and reliable measure of the handover process. It provides a useful tool for monitoring and evaluating handover processes in health organisations, and it is recommended for use and further development. Relevance to clinical practice Monitoring handover is an important quality assurance process that is required to meet healthcare standards. This reliable and valid scale can be used in practice to monitor the quality of handover and provide information that can form the basis of education and training packages and guidelines to improve handover policies and processes. [ABSTRACT FROM AUTHOR]

Adverse events are common in acute clinical settings but little is known about these events occurring after Intensive Care discharge. This study aimed to develop a reliable and valid tool for exploring clinicians' opinions of factors associated with post-Intensive Care adverse events. A convenience sample of Australian Intensive Care Liaison Nurses was invited to complete and appraise a questionnaire using structured guidelines. Content validity and internal consistency were assessed. Twelve Intensive Care Liaison Nurses completed the questionnaire. Cronbach?s alpha coefficient showed high internal consistency for the questionnaire; all 24 items on the questionnaire had coefficients greater than 0.852. The content validity index of the questionnaire overall was 0.76. The post-Intensive Care adverse events questionnaire demonstrated reliability and validity. It is a tool that can be used to explore clinicians? opinions of factors associated with these events. The tool is important as it facilitates further insight into the causes of post-Intensive Care adverse events. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore emergency department ( ED) nurses' perceptions of current practices and essential components of effective change of shift nursing handover. Background Ineffective nursing handover can negatively impact on patient outcomes. Evidence suggests that nursing handover in ED is highly variable. Proposed handover models in the literature are structured for inpatient settings and may not be suitable for ED settings. Design A mixed methods study (survey and group interviews) was conducted in a metropolitan ED in Melbourne, Australia. Methods During February- June 2011, a survey ( n = 63) investigated perceptions of current practices and preferences for handover structure. Analyses are descriptive. In the same period, group interviews ( n = 41) explored nurses' opinions about essential features and information of an effective nursing handover in the ED environment. A modified nominal group technique generated data that were analysed using content analysis. Results Most nurses (96%) perceived receiving adequate information during handover; however, gaps were identified, including omission of important information regarding medications, vital signs and nursing care needs. Group interviews identified five essential features of effective handover: systematic approach, treatment, appropriate environment, reference to documentation/charts and efficient communication. Essential information included patient details, presenting problem, future care/disposition plan, treatment and nursing observations. Conclusion Handover structures in the ED may not provide essential information to ensure adequate continuity of nursing care. ED nurses consider optimal handover to be specific for patients for whom they are caring, conducted at the bedside, structured and containing key elements (patient details, presenting problem, treatment, nursing observations, plan). Relevance to clinical practice Provision of a handover framework incorporating key features and essential information has the potential to improve the efficiency of handover. Use of this framework may enhance the transfer of accurate and essential information to enable safe and high standards of nursing care in the ED. [ABSTRACT FROM AUTHOR]

Aims To report a descriptive study of fertility-awareness knowledge, attitudes, and practice of infertile women seeking fertility assistance. Background Previous research has suggested that poor fertility-awareness may be a contributing cause of infertility among women seeking fertility assistance at assisted reproductive technology clinics. The actual practices and attitudes towards fertility-awareness in this particular group of women are unknown. Design A cross-sectional questionnaire-based survey. Methods The study was conducted over 6 months, from 2007-2008, of women on admission to two assisted reproductive technology clinics in a major city in Australia. Results Two hundred and four of 282 distributed questionnaires were completed (response rate = 72·3%). Eighty-three per cent had attempted conception for 1 year or more, 86·8% actively tried to improve their fertility-awareness from one or more sources of the information, 68·2% believed they had timed intercourse mainly within the fertile window of the menstrual cycle in their attempts at conception, but only 12·7% could accurately identify this window. Ninety-four per cent believe that a woman should receive fertility-awareness education when she first reports trouble conceiving to her doctor. Conclusions Most women seeking assistance at assisted reproductive technology clinics attempt timed intercourse within the fertile window of the menstrual cycle. However, few accurately identify this window, suggesting that poor fertility-awareness may be a contributing cause of infertility. [ABSTRACT FROM AUTHOR]

The article discusses a study on education received by residentialaged care staff regarding later life sexuality and sexual health. Topics include assessment of sexual health and needs of Australian aged care residents, survey design of the study and results and relevance of the study to tackle sexual health problems in aged residents.

Aims and objectives. The study aim was to develop a service evaluation tool for an advance care planning model implemented in community palliative care. Background. Internationally, advance care planning programmes usually measure success by completion rate of advance directives or plans. This outcome measure provides little information to assist nurse managers to embed advance care planning into usual care and measure their performance and quality over time. An evaluation tool was developed to address this need in Australian community palliative care services. Design. Multisite action research approach. Methods. Three community palliative care services located in Victoria, Australia, participated. Qualitative and quantitative data collection strategies were used to develop the Advance Care Planning-Service Evaluation Tool. Results. The Advance Care Planning-Service Evaluation Tool identified advance care planning progress over time across three stages of Establishment, Consolidation and Sustainability within previously established Model domains of governance, documentation, practice, education, quality improvement and community engagement. The tool was used by nurses either as a peer-assessment or self-assessment tool that assisted services to track their implementation progress as well as plan further change strategies. Conclusion. The Advance Care Planning-Service Evaluation Tool was useful to nurse managers in community palliative care. It provided a clear outline of service progress, level of achievement and provided clear direction for planning future changes. Relevance to clinical practice. The Advance Care Planning-Service Evaluation Tool enables nurses in community palliative care to monitor, evaluate and plan quality improvement of their advance care planning model to improve end-of-life care. As the tool describes generic healthcare processes, there is potential transferability of the tool to other types of services. [ABSTRACT FROM AUTHOR]